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1. Double-Network Hydrogel 3D BioPrinting Biocompatible with Fibroblast Cells for Tissue Engineering Applications

Author

Immacolata Greco, Hatim Machrafi, and Carlo S. Iorio

Subjects
bioprinting, double network, biocompatibility, hydrogels, tissue engineering, Science, Chemistry, QD1-999, Inorganic chemistry, QD146-197, General. Including alchemy, QD1-65
Abstract

The present study examines the formulation of a biocompatible hydrogel bioink for 3D bioprinting, integrating poly(ethylene glycol) diacrylate (PEGDA) and sodium alginate (SA) using a double-network approach. These materials were chosen for their synergistic qualities, with PEGDA contributing to mechanical integrity and SA ensuring biocompatibility. Fibroblast cells were included in the bioink and printed with a Reg4Life bioprinter employing micro-extrusion technology. The optimisation of printing parameters included needle size and flow velocities. This led to precise structure development and yielded results with a negligible deviation in printed angles and better control of line widths. The rheological characteristics of the bioink were evaluated, demonstrating appropriate viscosity and shear-thinning behaviour for efficient extrusion. The mechanical characterisation revealed an average compressive modulus of 0.38 MPa, suitable for tissue engineering applications. The printability of the bioink was further confirmed through the evaluations of morphology and diffusion rates, confirming structural integrity. Biocompatibility assessments demonstrated a high cell viability rate of 82.65% following 48 h of incubation, supporting the bioink’s suitability for facilitating cell survival. This study introduced a reliable technique for producing tissue-engineered scaffolds that exhibit outstanding mechanical characteristics and cell viability, highlighting the promise of PEGDA–SA hydrogels in bioprinting applications.

Published
2024
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2. Well Design Challenges in Geothermal Energy Applications

Author

Daniele Farina, Vanessa S. Iorio, Pasquale Mangano, Domenico Santoro, Luca Dal Forno, and Carla Sanasi

Subjects
Chemical engineering, TP155-156, Computer engineering. Computer hardware, TK7885-7895
Abstract

Geothermal resources represent precious energy sources to ensure sustainable power generation. As proposed in the majority of the future sustainable energy scenarios, geothermal energy exploitation is going to play a significant role in the energy mix to meet carbon neutrality target. Upon the different technologies involved, geothermal wells constitute the core and turning point for proper fluid/heat mining. Indeed, the number of suitable candidates for geothermal applications could be significantly enhanced by overcoming a series of wells related technological issues. Therefore, the object of this work is to provide a general overview of the principal challenges that characterized well design and construction in geothermal applications which are mainly related to the type of geological system and its relative temperature level. As a matter of fact, reservoir temperature guides most of the choices referring to geothermal systems not only in the selection of the final energy application purpose (direct use, power generation, combined heat and power) but also in well design definition. Based on temperature range, geothermal fields are usually grouped in enthalpy classes (low, medium and high) referring to fields characterized by similar energy potential. From a well design and construction perspective, the low and medium enthalpy classes, in the range of temperature lower than 150 °C, do not present specific criticalities. On the contrary, high enthalpy scenarios, for temperatures higher than 170 °C, present many challenges for most of the current drilling and completion technologies. Even though some field applications exist in high/ultra-high enthalpy scenarios, they still present an elevated risk of failure. Therefore, dedicated studies shall be conducted for all the elements involved in the well construction process such as: drilling fluids, cement slurry, metallurgy, drilling and completion equipment to properly account for their specific technical limitations. In this framework, a clear picture of the actual technical gaps constitutes the starting point for current and next research activities. In the close future, the growing interest in geothermal applications will surely boost the born and development of dedicated tools to unlock the enormous potential of geothermal energy.

Published
2023
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3. A Contribution to UHS – Overview of Different Approaches on Well Assessment in Depleted Reservoirs

Author

Vanessa S. Iorio, Federico Cracolici, Lucia Torri, Giacomo Nutricato, Fabio Parrozza, Luigina M.F. Sabatino, and Maria Elena Gennaro

Subjects
Chemical engineering, TP155-156, Computer engineering. Computer hardware, TK7885-7895
Abstract

Hydrogen is a carbon-free energy carrier, and it will become one of the main energy carriers in the future sustainable energy system. In an energy system based on renewable energy resources hydrogen will be the energy carrier that can be cost-efficiently transported and stored to deliver renewable energy from remote resource areas, at the right time and place to the energy demand. Regarding the production of hydrogen from renewable energy sources, the problem of hydrogen storage arises. Underground hydrogen storage in salt caverns, deep aquifers, and depleted reservoirs for strategic or seasonal purposes is being considered today. H2 storage in depleted reservoirs is surely the solution that maximizes the environmental and economic benefits, as it would allow the reuse of existing wells and infrastructures after their exploitation lifetime, minimizing emissions and investment/operating costs. In this type of storage, well integrity plays a significant role. The wells must be able to withstand extreme conditions and various loads during the entire service life. Considering the small size of the molecule of H2 and its strong diffusion, the impact of hydrogen on steel materials, elastomers, and cement shall be deeply evaluated, to avoid corrosion phenomena or stresses led by a combination of H2 at different temperatures and pressures.The paper aims to assess the hydrogen impact on the different materials of wells (metals, elastomers, and cement), with a particular focus on finding technical gaps in materials installed in already existing wells. This scope of work will be carried out through the analysis of data available in the literature and technical discussions with some of the Oil & Gas main Service Contractors. At present, API steel alloys normally deployed in Underground Gas Storage facilities are not tested specifically for the storage of hydrogen or hydrogen-enriched natural gas mixtures.As per literature analysis, streams with H2 concentration less than 0.5% look not to be critical for standard well equipment. On the other hand, when percentages of hydrogen get higher than 10%, only a few studies are available and it looks that the H2 effect cannot be considered negligible, leading to the consideration that well components in direct contact with the fluid shall be hydrogen resistant. However, due to the lack of available data, ad hoc tests are recommended.

Published
2023
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4. Enhanced electrical conductivity and stretchability of ionic-liquid PEDOT:PSS air-cathodes for aluminium-air batteries with long lifetime and high specific energy

Author

Hatim Machrafi, Fabio Iermano, Souhail Temsamani, Ilija Bobinac, and Carlo S. Iorio

Subjects
Medicine, Science
Abstract

Abstract A hydrogel film, poly-3,4-ethylenedioxythiophene (PEDOT):polystyrenesulfonate (PSS), containing an ionic liquid, is used as an air–cathode for a metal-air battery and its performance is investigated. This work presents the development of the air–cathode and the characterization of its physical, chemical and mechanical properties. Moreover, in view of wearable batteries, these air-cathodes are implemented within a flexible aluminium-air battery. It contains an aluminium anode, an electrolyte made of cellulose paper imbibed with an aqueous sodium chloride solution and the PEDOT:PSS air–cathode. Characterisation tests showed that the ionic liquid did not change the air–cathode chemically, while the electric conductivity increased considerably. The anode has an acceptable purity and was found to be resistant against self-corrosion. Discharge tests showed operating voltages up to 0.65 V, whereas two batteries in series could deliver up to 1.3 V at a current density of 0.9 mA cm−2 for almost a day, sufficient for monitoring and medical devices. Several discharge tests with current densities from 0.25 up to 2.5 mA cm−2 have presented operating lifetimes from 10 h up until over a day. At a current density of 2.8 mA cm−2, the operating voltage and lifetime dropped considerably, explained by approaching the limiting current density of about 3 mA cm−2, as evidenced by linear sweep voltammetry. The batteries showed high specific energies up to about 3140 Wh kg−1. Mechanical tests revealed a sufficient stretchability of the air–cathode, even after battery discharge, implying an acceptable degree of wearability. Together with the reusability of the air–cathode, the battery is a promising route towards a low-cost viable way for wearable power supply for monitoring medical devices with long lifetimes and high specific energies. Optimization of the air–cathode could even lead to higher power applications.

Published
2022
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5. Cement to Safeguard the Wells Integrity in Underground Hydrogen Storage: an Experimental Investigation

Author

Vanessa S. Iorio, Federico Cracolici, Fabio Parrozza, Luigina M. F. Sabatino, Elisabetta Previde Massara, Alberto Consonni, Chiara Tritto, and Michela De Simoni

Subjects
Chemical engineering, TP155-156, Computer engineering. Computer hardware, TK7885-7895
Abstract

Eni, like all the Energy companies, aims to accelerate the reduction of its carbon footprint by implementing the best applicable low-carbon solutions, and hydrogen is surely playing a fundamental role. Hydrogen is the simplest and most abundant element on the planet and an energy vector that has shown great promise worldwide as a solution for meeting climate challenges. This is because it can store and supply large quantities of energy without producing CO2 emissions during combustion. Once produced, the hydrogen needs to be stored for later consumption and here it becomes clear that the importance of Underground Hydrogen Storage (UHS) rises significantly. The main goal of any company is to find all the possible synergies with current activity and business. Even though injection in salt caverns has unquestionable benefits, hydrogen injection in depleted oil and gas reservoirs could be the solution to maximize efficiency and implement a circular economy approach. From an engineering point of view, before developing any Underground Hydrogen Storage (UHS) project, the first step is to analyze and study all the challenges related to this activity. Well suitability must be guaranteed during all the reinjection, in the following document a detail of this topic and especially of one of the main elements that have the role to safeguard the integrity of the well, which is the cement. This document aims to analyze the interaction of standard cement slurries used in oil and gas fields with hydrogen at standard reservoir conditions. The cement-hydrogen interaction tests shown in this document were conducted using autoclave as key instrumentation to simulate reservoir temperature and pressure conditions. The tests were designed and conducted using the methodological approach typical of the materials/fluids compatibility tests. Preliminary autoclave experimentation results show that hydrogen does not alter the chemical and physical characteristics of cement samples. This compatibility study of hydrogen is the first important step to further de-risk activities, the assurance of well integrity is critical and important in all stages to avoid any loss uncontrolled of hydrogen.

Published
2022
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7. Underground Hydrogen Storage in Depleted Gas Reservoirs: Opportunity Identification and Project Maturation Steps

Author

Chiara Tritto, Michela De Simoni, Ernesto Roccaro, Marco Pontiggia, Paola Panfili, Lucilla Del Gaudio, Luca Visconti, Vanessa S. Iorio, and Gianluca Dell'Elce

Subjects
Chemical engineering, TP155-156, Computer engineering. Computer hardware, TK7885-7895
Abstract

Depleted gas reservoirs represent a great opportunity for Hydrogen underground storage(UHS). Eni’s portfolio contains several late-life assets that indeed may provide significant storage capacity. These fields, identified as potential storage sites, are producing for several decades, thus they are accompanied by deep reservoir knowledge and infrastructure availability. Moreover, the caprock, that was able to store hydrocarbon during the past centuries, represents a containment potentially effective also when the reservoir acts as H2 storage site. In the framework of the energy transition, Eni has adopted a robust workflow allowing for the identification of UHS opportunities among its depleted assets portfolio. Starting from a first selection of the sites based on multidisciplinary available data, the most promising opportunities are then deepened through lab analyses, 3D numerical modelling and special studies. The special studies are devoted to understanding interactions among injected H2 and the reservoir fluids/rock but also with the active communities of microorganisms. Accurate studies are also needed to evaluate the effects of H2 during interaction with wells materials. In this paper, we will show the steps that lead Eni to identify and mature UHS opportunities.

Published
2022
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8. Printability of Double Network Alginate-Based Hydrogel for 3D Bio-Printed Complex Structures

Author

Immacolata Greco, Vanja Miskovic, Carolina Varon, Chiara Marraffa, and Carlo S. Iorio

Subjects
hydrogels, biomaterials, alginate, shape fidelity, ink viscosity, 3D bio-printing, Biotechnology, TP248.13-248.65
Abstract

Three-dimensional (3D) bio-printing has recently emerged as a crucial technology in tissue engineering, yet there are still challenges in selecting materials to obtain good print quality. Therefore, it is essential to study the influence of the chosen material (i.e., bio-ink) and the printing parameters on the final result. The “printability” of a bio-ink indicates its suitability for bio-printing. Hydrogels are a great choice because of their biocompatibility, but their printability is crucial for exploiting their properties and ensuring high printing accuracy. However, the printing settings are seldom addressed when printing hydrogels. In this context, this study explored the printability of double network (DN) hydrogels, from printing lines (1D structures) to lattices (2D structures) and 3D tubular structures, with a focus on printing accuracy. The DN hydrogel has two entangled cross-linked networks and a balanced mechanical performance combining high strength, toughness, and biocompatibility. The combination of poly (ethylene glycol)-diacrylate (PEDGA) and sodium alginate (SA) enables the qualities mentioned earlier to be met, as well as the use of UV to prevent filament collapse under gravity. Critical correlations between the printability and settings, such as velocity and viscosity of the ink, were identified. PEGDA/alginate-based double network hydrogels were explored and prepared, and printing conditions were improved to achieve 3D complex architectures, such as tubular structures. The DN solution ink was found to be unsuitable for extrudability; hence, glycerol was added to enhance the process. Different glycerol concentrations and flow rates were investigated. The solution containing 25% glycerol and a flow rate of 2 mm/s yielded the best printing accuracy. Thanks to these parameters, a line width of 1 mm and an angle printing inaccuracy of less than 1° were achieved, indicating good shape accuracy. Once the optimal parameters were identified, a tubular structure was achieved with a high printing accuracy. This study demonstrated a 3D printing hydrogel structure using a commercial 3D bio-printer (REGEMAT 3D BIO V1) by synchronizing all parameters, serving as a reference for future more complex 3D structures.

Published
2022
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9. High-frequency temperature pulse-response behavior through a porous nanocomposite scaffold for measuring the uptake of biologic

Author

Christophe Minetti, Carlo S. Iorio, and Hatim Machrafi

Subjects
high-frequency pulse-response, extended thermodynamics, self-assembled porous nanocomposite, biological fluid uptake, relaxation time, Biotechnology, TP248.13-248.65, Mathematics, QA1-939
Abstract

The measurement of biological fluid uptake into a scaffold sensor has been modeled by measuring the response of induced high-frequency temperature pulses. For this, a heat transport equation is used, developed from Extended Thermodynamics, also equivalent to Cattaneo's equation, as well as an effective thermal conductivity. The effective thermal conductivity is experimentally validated against data measurements of a carbon nanotube porous nanocomposite, embedded with silica nanoparticles. This nanocomposite serves also as the case study for the scaffold sensor. The uptake of the biological fluid in this scaffold sensor is equivalent to a change in the effective thermal conductivity, monitored by an increase of the interstitial volume fraction. By imposing a high-frequency temperature oscillation, the temperature response at the other end of the porous medium is calculated. Depending on the ratio of the relaxation time and the thermal diffusion time, the temperature response can be of oscillatory nature or of an exponential growth to an asymptotic limit. It is observed that an observed phase lag in the temperature response indicates a change in the effective thermal conductivity and thus is a criterion denoting the amount of uptake.

Published
2019
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11. Use of carotid artery cannulation during redo sternotomy in congenital cardiac surgery: a single-centre experience

Author

Francesca Iodice, Sergio Filippelli, Gianluca Brancaccio, Gianluigi Perri, Matteo Trezzi, Lorenzo Galletti, Antonio Amodeo, Fiore S. Iorio, Marco Della Porta, and Mizar D'Abramo

Subjects
Reoperation, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Heart Injury, Carotid Artery, Common, Carotid arteries, 030204 cardiovascular system & hematology, Catheterization, law.invention, Congenital, 03 medical and health sciences, 0302 clinical medicine, law, medicine.artery, medicine, Cardiopulmonary bypass, Humans, In patient, Common carotid artery, Cardiac Surgical Procedures, Retrospective Studies, Cardiopulmonary Bypass, business.industry, Sternotomy, Surgery, Cardiac surgery, Single centre, 030228 respiratory system, Composite graft, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVES Management of resternotomy is often a difficult challenge in patients with congenital diseases who have undergone multiple sternotomies. Our goal was to report our single-centre experience with carotid cannulation using a graft interposed during redo sternotomy in complex cardiac reintervention procedures. METHODS We performed a retrospective review of all patients who had undergone complex redo sternotomies between January 2019 and May 2020 utilizing a cervical cannulation technique with a Gore-Tex graft interposed on the carotid artery. We classified our population study on the basis of the primary diagnosis and the type of surgery. The primary outcomes of our analysis were the evaluation of the safety of the procedure in terms of survival and freedom from neurological events. RESULTS We analysed 22 patients who had undergone previous complex operations. The median age and weight at the time of reintervention were 130.35 (range 0.46–435) months and 31.5 (range 2.2–85) kg, respectively. Composite graft carotid cannulation provided adequate arterial flow in all patients with a median arterial flow of 3.5 l/min/m2 (range 0.6–6). One major cardiac injury occurred during sternotomy when emergency cardiopulmonary bypass (CPB) was initiated. Moreover, during their hospital stays, all patients had an uneventful recovery without neurological or vascular complications and no cervical wound infections. CONCLUSIONS Carotid cannulation using interposition of a side graft on the common carotid artery for arterial inflow is a reliable and safe method for initiation of CPB in complex redo surgeries in patients with congenital disease. Complications directly associated with this type of cannulation are uncommon and allow surgical re-entry with overall low risks.

Published
2021
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12. Predictors of survival in paediatric mitral valve replacement

Author

Francesca Iodice, Ileana Croci, Adriano Carotti, Chiara Giorni, Gianluca Brancaccio, Roberta Iacobelli, Lorenzo Galletti, Matteo Trezzi, Walter Vignaroli, Carolina D'Anna, Fiore S. Iorio, and Marcello Chinali

Subjects
Pulmonary and Respiratory Medicine, Prosthetic valve, Univariate analysis, medicine.medical_specialty, business.industry, medicine.medical_treatment, Mitral valve replacement, Retrospective cohort study, General Medicine, 030204 cardiovascular system & hematology, Prosthesis, Surgery, Transplantation, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030228 respiratory system, Interquartile range, Mitral valve, medicine, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVES The aim of this study was to identify the predictors of death and of reintervention after mitral valve replacement (MVR) in children. METHODS A single-centre retrospective study was performed including 115 patients under the age of 18 undergoing MVR between 1982 and 2019. For all patients, the ratio of prosthetic valve size (diameter in mm) to weight (kg) at surgery was calculated and long-term result was assessed. The primary outcome was freedom from mitral valve (MV) re-replacement. The composite secondary outcome was freedom from death or transplant. RESULTS Fifty-four patients had a previous surgical attempt to MV repair. The median age at surgery was 5.5 years (interquartile range 1.21–9.87). Death/transplant-free survival was 77 ± 4% at 5 years and 72 ± 5% at 10 years. Univariate analysis showed a size/weight ratio higher than 2 and age CONCLUSIONS MVR is a viable strategy in children with unrepairable MV disease. Mortality can be predicted based on size/weight ratio and age

Published
2021
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13. Perceived health and interaction with healthcare workers of a hard-to-reach group in a Roman suburb

Author

S Caminada, F Turatto, A Jaljaa, E Mazzalai, D Giannini, S Iorio, M Errigo, L Paglione, M Marceca, and A Brandimarte

Subjects
Public Health, Environmental and Occupational Health
Abstract

Previous studies have showed that people living in Bastogi - a segregated and deprived peripheral area of Rome- have difficulties in accessing and relating to health services. Our aim was to analyze the health perception, health-related behaviors, and the interaction between healthcare professionals and the census population living in Bastogi, compared to the population living in the area of the same local health unit, ASL Roma 1 (hereafter ASL). The PASSI survey (from the Italian Surveillance System) was administered by phone and through door-to-door interviews to a sample of 210 residents of Bastogi. Data were analyzed and compared to the ones of the ASL collected in 2017-2018. Descriptive and univariate analysis were performed with STATA 13. P-values ≤ 0.05 were considered statistically significant. The socio-economic indicators, acknowledged determinants of health inequalities, showed a worse condition for the inhabitants of Bastogi. There was a significantly higher proportion of foreign and unemployed residents in Bastogi, with a lower educational level compared to the ASL. 58.1 % of the Bastogi group claimed their health to be good/very good (ASL: 71.6%; p = 0.000). 56.2% of the respondents from Bastogi were current smokers (ASL: 25.8%; p = 0.000). Risk factors for and prevalence of chronic diseases were significantly higher in Bastogi. The proportion of respondents who stated they had not had any recent contact with health professionals was significantly higher, and mammogram screening uptake was lower (75.3%; ASL: 90.4%; p = 0.001). Despite their lower help-seeking behavior, our study pointed out that the respondents from Bastogi who had had a contact with a health professional reported a higher perceived interest about their health than in the ASL. Further studies are needed to investigate whether this attention is attributable to the higher prevalence of chronic diseases or to the health professional's awareness of vulnerability of a hard-to-reach group. Key messages The population from Bastogi is marginalized and hard-to-reach: we found a worse overall self- reported health condition, a worse help-seeking behavior and a lack of reliance on health professionals. The PASSI survey administration has led to a greater involvement of the competent health institution, which resulted in the introduction of a community nurse and a Single Access Point.

Published
2021
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15. The Sclerosing Cholangitis Outcomes in Pediatrics (SCOPE) Index: A Prognostic Tool for Children

Author

Deneau, M.R. Mack, C. Perito, E.R. Ricciuto, A. Valentino, P.L. Amin, M. Amir, A.Z. Aumar, M. Auth, M. Broderick, A. DiGuglielmo, M. Draijer, L.G. Tavares Fagundes, E.D. El-Matary, W. Ferrari, F. Furuya, K.N. Gupta, N. Hochberg, J.T. Homan, M. Horslen, S. Iorio, R. Jensen, M.K. Jonas, M.M. Kamath, B.M. Kerkar, N. Kim, K.M. Kolho, K.-L. Koot, B.G.P. Laborda, T.J. Lee, C.K. Loomes, K.M. Martinez, M. Miethke, A. Miloh, T. Mogul, D. Mohammad, S. Mohan, P. Moroz, S. Ovchinsky, N. Palle, S. Papadopoulou, A. Rao, G. Rodrigues Ferreira, A. Sathya, P. Schwarz, K.B. Shah, U. Shteyer, E. Singh, R. Smolka, V. Soufi, N. Tanaka, A. Varier, R. Vitola, B. Woynarowski, M. Zerofsky, M. Zizzo, A. Guthery, S.L.

Abstract

Background and Aims: Disease progression in children with primary sclerosing cholangitis (PSC) is variable. Prognostic and risk-stratification tools exist for adult-onset PSC, but not for children. We aimed to create a tool that accounts for the biochemical and phenotypic features and early disease stage of pediatric PSC. Approach and Results: We used retrospective data from the Pediatric PSC Consortium. The training cohort contained 1,012 patients from 40 centers. We generated a multivariate risk index (Sclerosing Cholangitis Outcomes in Pediatrics [SCOPE] index) that contained total bilirubin, albumin, platelet count, gamma glutamyltransferase, and cholangiography to predict a primary outcome of liver transplantation or death (TD) and a broader secondary outcome that included portal hypertensive, biliary, and cancer complications termed hepatobiliary complications (HBCs). The model stratified patients as low, medium, or high risk based on progression to TD at rates of

Published
2021

16. Anomalous aortic origin of the pulmonary arteries: Case series and literature review

Author

Felice Davide Calvaruso, Salvatore Agati, Daniela Poli, Aurelio Secinaro, Simone Reali, Luca Borro, Fiore S. Iorio, Ivana Campanella, Rosanna Zanai, Carlos Guerra Sousa, Alfredo Di Pino, Massimiliano Raponi, Andrea Zorzi, and Robert H. Anderson

Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, lcsh:Medicine, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Internal medicine, Ascending aorta, medicine, Ventricular outflow tract, persistent ductus arteriosus, Tetralogy of Fallot, Aorta, neonatal diagnosis, Respiratory distress, business.industry, fetal diagnosis, lcsh:R, lcsh:RJ1-570, lcsh:Pediatrics, medicine.disease, State of the Art, 030228 respiratory system, lcsh:RC666-701, Heart failure, Pediatrics, Perinatology and Child Health, Pulmonary artery, Ventricular pressure, Cardiology, Cardiology and Cardiovascular Medicine, business, Direct reimplantation of pulmonary artery, pulmonary artery and neonatal urgency
Abstract

Anomalous origin of the pulmonary arteries from the ascending aorta is a rare, but severe clinical entity necessitating a scrupulous evaluation. Either the right or the left pulmonary arteries can arise directly from the ascending aorta while the other pulmonary artery retains its origin from the right ventricular outflow tract. Such a finding can be isolated or can coexist with several congenital heart lesions. Direct intrapericardial aortic origin, however, must be distinguished with origin through a persistently patent arterial duct. In the current era, clinical manifestations usually become evident in the newborn rather than during infancy, as used to be the case. They include respiratory distress or congestive heart failure due to increased pulmonary flow and poor feeding. The rate of survival has now increased due to early diagnosis and prompt surgical repair, should now be expected to be at least 95%. We have treated four neonates with this lesion over the past 7 years, all of whom survived surgical repair. Right ventricular systolic pressure was significantly decreased at follow-up. Our choice of treatment was to translocate the anomalous pulmonary artery in end-to-side fashion to the pulmonary trunk. Our aim in this report is to update an Italian experience in the diagnosis and treatment of anomalous direct origin of one pulmonary artery from the aorta, adding considerations on the lessons learned from our most recent review of the salient literature.

Published
2019

17. Anomalous Origin of Left Common Carotid Artery From Left Pulmonary Artery in a 22q11.2 Deletion Syndrome Newborn With Right Aortic Arch and Aberrant Left Subclavian Artery

Author

Aurelio Secinaro, Walter Vignaroli, Fiore S. Iorio, Sergio Filippelli, Davide Curione, and Gianluigi Perri

Subjects
Male, Aortic arch, medicine.medical_specialty, Carotid Artery, Common, Computed Tomography Angiography, Vascular Malformations, Cardiovascular Abnormalities, Subclavian Artery, Aorta, Thoracic, Imaging, Three-Dimensional, Suture (anatomy), medicine.artery, Internal medicine, Ductus arteriosus, DiGeorge Syndrome, medicine, Humans, Abnormalities, Multiple, Radiology, Nuclear Medicine and imaging, Deletion syndrome, Common carotid artery, business.industry, Infant, Vascular ring, Left pulmonary artery, medicine.disease, medicine.anatomical_structure, Pulmonary artery, Cardiology, Cardiology and Cardiovascular Medicine, business
Published
2020
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18. Airway Compression by a Right Aortic Arch in the Absence of a Vascular Ring

Author

Felice Davide Calvaruso, Fiore S. Iorio, Aurelio Secinaro, Rosanna Zanai, Robert H. Anderson, Carlos Guerra Sousa, Simone Reali, Ivana Campanella, Salvatore Agati, and Giuseppe Ferro

Subjects
Aortic arch, business.industry, Vascular ring, Arterial duct, General Medicine, Anatomy, medicine.disease, Bronchial compression, Airway compression, medicine.artery, Pediatrics, Perinatology and Child Health, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Published
2019

19. Long-Term Outcomes After Extracardiac Fontan Takedown to an Intermediate Palliative Circulation

Author

Fiore S. Iorio, Salvatore Giannico, Adriano Carotti, Sonia B. Albanese, Matteo Trezzi, and Enrico Cetrano

Subjects
Pulmonary and Respiratory Medicine, Heart Defects, Congenital, Male, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Palliative care, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Fontan Procedure, Fontan procedure, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, medicine, Long term outcomes, Humans, cardiovascular diseases, Child, Survival rate, Retrospective Studies, Heart transplantation, business.industry, Mortality rate, Palliative Care, Infant, Retrospective cohort study, Surgery, Survival Rate, surgical procedures, operative, Treatment Outcome, 030228 respiratory system, Italy, Child, Preschool, Female, Morbidity, Cardiology and Cardiovascular Medicine, business, Shunt (electrical), Follow-Up Studies
Abstract

Background Acute failure of the Fontan circulation is rare but remains associated with high morbidity and mortality rates. Little is known about the long-term outcome of patients who underwent Fontan takedown to an intermediate palliative circulation and their potential candidacy for redo Fontan completion. Methods Patients followed up at a single institution who underwent takedown of a Fontan circulation to an intermediate palliative circulation within 2 months of extracardiac Fontan completion were reviewed. Results Between October 1990 and December 2015, 18 patients underwent Fontan takedown to a superior cavopulmonary connection (with or without an additional shunt) at a median age of 3.3 years (range, 1.8 to 8.0) and median weight of 13.8 kg (range, 8.0 to 27.0 kg). Takedown was required during the Fontan procedure itself in 2 patients, and within the first 2 postoperative months in 16 patients (median time to takedown, 3 days). Seventeen patients survived the post–takedown period and 3 ultimately underwent successful redo Fontan. Four patients required heart transplantation, with 2 deaths. In patients with extended intermediate palliation, median arterial oxygen saturation was 84% (range, 76% to 92%) at a median follow-up of 6.3 years (range, 0.7 to 25.9). Conclusions Takedown to a superior cavopulmonary connection is an effective treatment option and, in some patients, acts as a bridge to subsequent redo Fontan completion or heart transplantation. An extended intermediate palliative circulation is tolerated for several years with reasonable oxygen saturation levels at rest. In our experience, an early takedown strategy to a superior cavopulmonary connection is the treatment of choice for acute Fontan failure.

Published
2017

20. Surgical treatment of arrhythmias related to congenital heart diseases

Author

Sandra Giusti, Adele Borghi, Vittorio Vanini, Fiore S. Iorio, Giancarlo Crupi, and Gabriele Vignati

Subjects
Adult, Heart Defects, Congenital, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, Heart disease, Radiofrequency ablation, medicine.medical_treatment, Cryotherapy, law.invention, law, Tachycardia, Supraventricular, Humans, Medicine, cardiovascular diseases, Cardiac Surgical Procedures, Atrium (heart), Child, Supraventricular arrhythmia, business.industry, Cryoablation, Middle Aged, Ablation, medicine.disease, Surgery, medicine.anatomical_structure, Child, Preschool, cardiovascular system, Female, Cardiology and Cardiovascular Medicine, Complication, business, Follow-Up Studies
Abstract

Background Supraventricular arrhythmias complicate operated and unoperated congenital heart disease, especially when atrial dilatation coexists. Methods We evaluated the results of intraoperative ablation in a group of 23 patients with chronic supraventricular tachyarrhythmias (mostly intraatrial reentry) that were unresponsive to conventional medical therapy. All procedures were performed consecutively between September 1999 and November 2001. Ablation was done during redo operations (Fontan conversion to total cavopulmonary connection in 16 patients) in 18 patients and during primary surgical correction in 5 patients. The mean age at operation was 25 ± 12 years (2 to 50 years). Cryoablation was done in 10 patients and radiofrequency ablation in 13 patients. Nineteen patients had ablation in one atrium and 4 had ablation in both atria. A generous atrial reduction was always performed at the end of the operation. Results The operative mortality rate was 13% (3 patients) from causes unrelated to ablation. In 20 survivors, the ablation was effective immediately. Eight patients required a permanent pacemaker. During a mean follow-up of 22 ± 4 months, atrial arrhythmias recurred in 25% (5 patients) and were controlled with medical therapy, whereas 1 patient required pacemaker implantation. Conclusions Intraoperative treatment of unresponsive atrial tachyarrhythmias associated with operated or unoperated congenital heart disease is feasible and the midterm results are encouraging.

Published
2003
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21. Fast-track congenital heart operations: a less invasive technique and early extubation

Author

Doff B. McElhinney, Fiore S. Iorio, Carlo Marcelletti, Raul Abella, Luisa Colagrande, Stefano M. Marianeschi, Francesco Seddio, Marco Meli, and Teresa de la Torre

Subjects
Adult, Heart Defects, Congenital, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, Adolescent, Heart disease, medicine.medical_treatment, Bicuspid aortic valve, Intubation, Intratracheal, Humans, Minimally Invasive Surgical Procedures, Medicine, Intubation, Atrioventricular Septal Defect, Cardiac Surgical Procedures, Child, Sinus (anatomy), Postoperative Care, business.industry, Infant, medicine.disease, Surgery, Stenosis, medicine.anatomical_structure, Median sternotomy, Child, Preschool, Anesthesia, Fast track, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Background . Many novel techniques have been described for "minimally invasive" congenital cardiac operations to achieve an improved cosmetic result. There is little information on incorporation of such techniques into fast-track congenital heart operations. Methods . We have developed an approach to fast-track congenital heart operations, which includes a cosmetic approach for repair of congenital heart defects without sacrificing adequate exposure or requiring specialized equipment, along with a simple approach to intraoperative anesthetic management that allows extubation in the operating room. The heart is exposed through a short midline skin incision and a full median sternotomy. The conventional technique of cannulation is performed. Between October 1997 and January 1999, 88 patients were operated on with this method. Cardiac anomalies included simple and complex ostium secundum atrial septal defect, sinus venous atrial septal defect, partial atrioventricular septal defect, simple and complex ventricular septal defect, and bicuspid aortic valve stenosis. Results . There were no operative or late deaths. The majority of patients were extubated in the operating room or within 2 hours of operation. No patient underwent reoperation and the mean length of hospital stay was 3.9 days. Sternal instability or wound infection were not observed. Conclusions . We believe that our approach to fast-track congenital heart operation is safe and effective. The surgical technique provides good exposure and has excellent cosmetic results. Moreover, it is easy to learn and, if necessary, the surgeon can quickly gain direct access to the heart. The anesthetic management facilitates early tracheal extubation and a shorter duration of postoperative stay.

Published
2000
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22. Revision of previous Fontan connections to total extracardiac cavopulmonary anastomosis: A multicenter experience

Author

Fiore S. Iorio, Raul Abella, Carl L. Backer, Stefano M. Marianeschi, Constantine Mavroudis, F. Fontan, Luisa Colagrande, Carlo Marcelletti, Ed Petrossian, Adriano Cipriani, Teresa de la Torre, V. Mohan Reddy, Frank L. Hanley, Doff B. McElhinney, and Francesco Seddio

Subjects
Adult, Heart Defects, Congenital, Reoperation, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Fontan Procedure, Inferior vena cava, Surgical anastomosis, Postoperative Complications, Internal medicine, Humans, Medicine, Treatment Failure, cardiovascular diseases, Child, Retrospective Studies, Heart transplantation, business.industry, Heart Bypass, Right, Perioperative, medicine.disease, Right pulmonary artery, Venous Obstruction, Surgery, Survival Rate, Cross-Sectional Studies, medicine.vein, Heart failure, Cardiology, cardiovascular system, business, Complication, Cardiology and Cardiovascular Medicine
Abstract

Background: Conversion to total extracardiac cavopulmonary anastomosis is an option for managing patients with dysfunction of a prior Fontan connection. Methods: Thirty-one patients (19.9 ± 8.8 years) underwent revision of a previous Fontan connection to total extracardiac cavopulmonary anastomosis at four institutions. Complications of the previous Fontan connection included atrial tachyarrhythmias (n = 20), progressive heart failure (n = 17), Fontan pathway obstruction (n = 10), effusions (n = 10), pulmonary venous obstruction by an enlarged right atrium (n = 6), protein-losing enteropathy (n = 3), right atrial thrombus (n = 2), subaortic stenosis (n = 1), atrioventricular valve regurgitation (n = 3), and Fontan baffle leak (n = 5). Conversion to an extracardiac cavopulmonary connection was performed with a nonvalved conduit from the inferior vena cava to the right pulmonary artery, with additional procedures as necessary. Results: There have been 3 deaths. Two patients died in the perioperative period of heart failure and massive effusions. The third patient died suddenly 8 months after the operation. All surviving patients were in New York Heart Association class I (n = 20) or II (n = 7), except for 1 patient who underwent heart transplantation. Early postoperative arrhythmias occurred in 10 patients: 4 required pacemakers, and medical therapy was sufficient in 6. In 15 patients, pre-revision arrhythmias were improved. Effusions resolved in all but 1 of the patients in whom they were present before revision. The condition of 2 patients with protein-losing enteropathy improved within 30 days. Conclusions: Conversion of a failing Fontan connection to extracardiac cavopulmonary connection can be achieved with low morbidity and mortality. Optimally, revision should be undertaken early in symptomatic patients before irreversible ventricular failure ensues. (J Thorac Cardiovasc Surg 2000;119:340-6)

Published
2000
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23. Percutaneous closure of paravalvular leak in children after left ventricular outflow enlargement by the Konno procedure with aortic valve mechanical prosthesis

Author

Paolo Guccione, Giacomo Pongiglione, Lilia Oreto, and Fiore S. Iorio

Subjects
Aortic valve, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Cardiac Catheterization, Percutaneous, Adolescent, Aortic Valve, Aortic Valve Insufficiency, Aortography, Child, Female, Heart Valve Prosthesis Implantation, Heart Ventricles, Humans, Septal Occluder Device, Severity of Illness Index, Treatment Outcome, Heart Valve Prosthesis, medicine.medical_treatment, Closure (topology), Prosthesis, Internal medicine, medicine, Paravalvular leak, business.industry, Settore MED/23 - Chirurgia Cardiaca, Surgery, medicine.anatomical_structure, Cardiology, Outflow, business, Cardiology and Cardiovascular Medicine
Published
2014

24. Partial atrioventricular canal with congestive heart failure in the first year of life: Surgical options

Author

Bruno Marino, Alessandro Giamberti, Andrea Zorzi, Duccio Di Carlo, Fiore S. Iorio, Roberto Formigari, and Carlo Marcelletti

Subjects
Heart Defects, Congenital, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Partial atrioventricular canal, Heart disease, First year of life, Aortic Coarctation, Postoperative Complications, Internal medicine, Mitral valve, medicine, Humans, Hospital Mortality, Heart Failure, business.industry, Infant, medicine.disease, Norwood Operation, Surgery, medicine.anatomical_structure, Echocardiography, Heart failure, cardiovascular system, Cardiology, Heart Transplantation, Mitral Valve, Female, Down Syndrome, Cardiology and Cardiovascular Medicine, business, Complication, Endocardial Cushion Defects, Follow-Up Studies, Left ventricular hypoplasia
Abstract

Background. An important subgroup of patients with partial atrioventricular canal require an operation in the first year of life because of refractory congestive heart failure. Methods. From June 1982 to April 1995, of 128 patients with partial atrioventricular canal, 35 patients (27%) underwent surgical treatment at less than 1 year of life. Associated cardiac anomalies were present in 22 patients. Only 7 patients (20%) had Down's syndrome. Five patients with left ventricular hypoplasia underwent aortic coarctectomy (3 patients) or Norwood operation (2 patients). The other 30 patients underwent anatomic repair in 24 cases and aortic coarctectomy in 6. The surgical results of patients submitted for anatomic repair were retrospectively correlated with the echocardiographic mitral valve diameter. Results. There were 7 deaths (29%) after anatomic repair, 2 (22%) after aortic coarctectomy, and 2 (100%) after Norwood operation. Infants with a mitral valve diameter less than 2.5 × 10 −2 m/m 2 died at repair. In a mean follow-up of 73.5 months there were five secondary mitral valve plasties and three repairs after aortic coarctectomy. Conclusions. Among patients with partial atrioventricular canal, there is an important subgroup with clinical signs of heart failure in the first year of life. Left-sided obstructive lesions and complex mitral valve anomalies seem to play a fundamental role in the clinical evolution and prognosis of these patients. The echocardiographic mitral valve diameter may be useful for determining the correct surgical indication.

Published
1996
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25. Dependence on pseudorapidity and on centrality of charged hadron production in PbPb collisions at root s(NN)=2.76 TeV

Author

Sirunyan, A. M. Tumasyan, A. Adam, W. Bergauer, T. and Dragicevic, M. Eroe, J. Fabjan, C. Friedl, M. and Fruehwirth, R. Ghete, V. M. Hammer, J. Haensel, S. Hoch, M. Hoermann, N. Hrubec, J. Jeitler, M. Kiesenhofer, W. and Krammer, M. Liko, D. Mikulec, I. Pernicka, M. and Rahbaran, B. Rohringer, H. Schoefbeck, R. Strauss, J. and Taurok, A. Teischinger, F. Trauner, C. Wagner, P. and Waltenberger, W. Walzel, G. Widl, E. Wulz, C. -E. and Mossolov, V. Shumeiko, N. Gonzalez, J. Suarez Bansal, S. and Benucci, L. De Wolf, E. A. Janssen, X. Luyckx, S. Maes, T. Mucibello, L. Ochesanu, S. Roland, B. Rougny, R. and Selvaggi, M. Van Haevermaet, H. Van Mechelen, P. Van Remortel, N. Blekman, F. Blyweert, S. D'Hondt, J. and Suarez, R. Gonzalez Kalogeropoulos, A. Maes, M. Olbrechts, A. Van Doninck, W. Van Mulders, P. Van Onsem, G. P. and Villella, I. Charaf, O. Clerbaux, B. De Lentdecker, G. and Dero, V. Gay, A. P. R. Hammad, G. H. Hreus, T. Marage, P. E. Raval, A. Thomas, L. Vander Marcken, G. Vander Velde, C. Vanlaer, P. Adler, V. Cimmino, A. Costantini, S. Grunewald, M. Klein, B. Lellouch, J. Marinov, A. and Mccartin, J. Ryckbosch, D. Thyssen, F. Tytgat, M. and Vanelderen, L. Verwilligen, P. Walsh, S. Zaganidis, N. and Basegmez, S. Bruno, G. Caudron, J. Ceard, L. Gil, E. Cortina De Jeneret, J. De Favereau Delaere, C. Favart, D. and Giammanco, A. Gregoire, G. Hollar, J. Lemaitre, V. and Liao, J. Militaru, O. Nuttens, C. Ovyn, S. Pagano, D. and Pin, A. Piotrzkowski, K. Schul, N. Beliy, N. and Caebergs, T. Daubie, E. Alves, G. A. Brito, L. De Jesus Damiao, D. Pol, M. E. Souza, M. H. G. Alda Junior, W. L. and Carvalho, W. Da Costa, E. M. De Oliveira Martins, C. Fonseca De Souza, S. Mundim, L. Nogima, H. Oguri, V. Prado Da Silva, W. L. Santoro, A. Silva Do Amaral, S. M. Sznajder, A. and Bernardes, C. A. Dias, F. A. Dos Anjos Costa, T. and Fernandez Perez Tomei, T. R. Gregores, E. M. Lagana, C. and Marinho, F. Mercadante, P. G. Novaes, S. F. Padula, Sandra S. Darmenov, N. Genchev, V. Iaydjiev, P. Piperov, S. and Rodozov, M. Stoykova, S. Sultanov, G. Tcholakov, V. and Trayanov, R. Vutova, M. Dimitrov, A. Hadjiiska, R. and Karadzhinova, A. Kozhuharov, V. Litov, L. Mateev, M. and Pavlov, B. Petkov, P. Bian, J. G. Chen, G. M. Chen, H. S. Jiang, C. H. Liang, D. Liang, S. Meng, X. Tao, J. and Wang, J. Wang, J. Wang, X. Wang, Z. Xiao, H. Xu, M. Zang, J. Zhang, Z. Ban, Y. Guo, S. Guo, Y. and Li, W. Mao, Y. Qian, S. J. Teng, H. Zhu, B. Zou, W. and Cabrera, A. Gomez Moreno, B. Ocampo Rios, A. A. Osorio Oliveros, A. F. Sanabria, J. C. Godinovic, N. Lelas, D. and Lelas, K. Plestina, R. Polic, D. Puljak, I. Antunovic, Z. Dzelalija, M. Kovac, M. Brigljevic, V. Duric, S. and Kadija, K. Luetic, J. Morovic, S. Attikis, A. Galanti, M. Mousa, J. Nicolaou, C. Ptochos, F. Razis, P. A. and Finger, M. Finger, Jr., M. Assran, Y. Kamel, A. Ellithi and Khali, S. Mahmoud, M. A. Radi, A. Hektor, A. Kadastik, M. Mfintel, M. Raidal, M. Rebane, L. Tiko, A. and Azzolini, V. Eerola, P. Fedi, G. Voutilainen, M. and Czellar, S. Harkonen, J. Heikkinen, A. Karimaki, V. and Kinnunen, R. Kortelainen, M. J. Lampen, T. Lassila-Perini, K. Lehti, S. Linden, T. Luukka, P. Maenpaa, T. and Tuominen, E. Tuominiemi, J. Tuovinen, E. Ungaro, D. and Wendland, L. Banzuzi, K. Karjalainen, A. Korpela, A. and Tuuva, T. Sillou, D. Besancon, M. Choudhury, S. and Dejardin, M. Denegri, D. Fabbro, B. Faure, J. L. Ferri, F. Ganjour, S. Gentit, F. X. Givernaud, A. Gras, P. and de Monchenault, G. Hamel Jarry, P. Locci, E. Les, J. Male and Marionneau, M. Millischer, L. Rander, J. Rosowsky, A. and Shreyber, I. Titov, M. Verrecchia, P. Baffioni, S. and Beaudette, F. Benhabib, L. Bianchini, L. Bluj, M. and Broutin, C. Busson, P. Chariot, C. Dahms, T. Dobrzynski, L. Elgammal, S. de Cassagnac, R. Granier Haguenauer, M. and Mine, P. Mironov, C. Ochando, C. Paganini, P. Sabes, D. and Salerno, R. Sirois, Y. Thiebaux, C. Wyslouch, B. and Zabi, A. Agram, J. -L. Andrea, J. Bloch, D. Bodin, D. and Brom, J-M. Cardaci, M. Chabert, E. C. Collard, C. and Conte, E. Drouhin, F. Ferro, C. Fontaine, J-C. Gele, D. and Goerlach, U. Greder, S. Juillot, P. Karim, M. Le Bihan, A-C. Mikami, Y. Van Hove, P. Fassi, F. Mercier, D. Baty, C. Beauceron, S. Beaupere, N. Bedjidian, M. and Bondu, O. Boudoul, G. Boumediene, D. Brun, H. Chasserat, J. Chierici, R. Contardo, D. Depasse, P. El Mamouni, H. and Fay, J. Gascon, S. Ille, B. Kurca, T. Le Grand, T. and Lethuillier, M. Mirabito, L. Perries, S. Sordini, V. and Tosi, S. Tschudi, Y. Verdier, P. Viret, S. Lomidze, D. and Anagnostou, G. Beranek, S. Edelhoff, M. Feld, L. and Heracleous, N. Hindrichs, O. Jussen, R. Klein, K. Merz, J. Mohr, N. Ostapchuk, A. Perieanu, A. Raupach, F. and Sammet, J. Schael, S. Sprenger, D. Weber, H. Weber, M. and Wittmer, B. Zhukov, V. Ata, M. Dietz-Laursonn, E. and Erdmann, M. Hebbeker, T. Heidemann, C. Hinzmann, A. and Hoepfner, K. Klimkovich, T. Klingebiel, D. Kreuzer, P. and Lanske, D. Lingemann, J. Magass, C. Merschmeyer, M. and Meyer, A. Papacz, P. Pieta, H. Reithler, H. Schmitz, S. A. Sonnenschein, L. Steggemann, J. Teyssier, D. and Bontenackels, M. Cherepanov, V. Davids, M. Fluegge, G. and Geenen, H. Giffels, M. Ahmad, W. Haj Hoehle, F. Kargoll, B. Kress, T. Kuessel, Y. Linn, A. Nowack, A. and Perchalla, L. Pooth, O. Rennefeld, J. Sauerland, P. and Stahl, A. Tornier, D. Zoeller, M. H. Martin, M. Aldaya and Behrenhoff, W. Behrens, U. Bergholz, M. Bethani, A. and Borras, K. Cakir, A. Campbell, A. Castro, E. Dammann, D. and Eckerlin, G. Eckstein, D. Flossdorf, A. Flucke, G. and Geiser, A. Hauk, J. Jung, H. Kasemann, M. Katsas, P. and Kleinwort, C. Kluge, H. Knutsson, A. Kraemer, M. and Kruecker, D. Kuznetsova, E. Lange, W. Lohmann, W. and Mankel, R. Marienfeld, M. Melzer-Pellmann, I. -A. Meyer, A. B. Mnich, J. Mussgiller, A. Olzem, J. Petrukhin, A. and Pitzl, D. Raspereza, A. Rosin, M. Schmidt, R. and Schoerner-Sadenius, T. Sen, N. Spiridonov, A. Stein, M. and Tomaszewska, J. Walsh, R. Wissing, C. Autermann, C. and Blobel, V. Bobrovskyi, S. Draeger, J. Enderle, H. and Gebbert, U. Goerner, M. Hermanns, T. Kaschube, K. and Kaussen, G. Kirschenmann, H. Klanner, R. Lange, J. Mura, B. Naumann-Emme, S. Nowak, F. Pietsch, N. Sander, C. and Schettler, H. Schleper, P. Schlieckau, E. Schroeder, M. and Schum, T. Stadie, H. Steinbrueck, G. Thomsen, J. Barth, C. Bauer, J. Berger, J. Buege, V. Chwalek, T. De Boer, W. Dierlamm, A. Dirkes, G. Feindt, M. Gruschke, J. and Hackstein, C. Hartmann, F. Heinrich, M. Held, H. and Hoffmann, K. H. Hone, S. Katkov, I. Komaragiri, J. R. and Kuhr, T. Martschei, D. Mueller, S. Mueller, Th. Niegel, M. Oberst, O. Oehler, A. Ott, J. Peiffer, T. Quast, G. Rabbertz, K. Ratnikov, F. Ratnikova, N. Renz, M. and Roecker, S. Saout, C. Scheurer, A. Schieferdecker, P. and Schilling, F. -P. Schmanau, M. Schott, G. Simonis, H. J. and Stober, F. M. Troendle, D. Wagner-Kuhr, J. Weiler, T. and Zeise, M. Ziebarth, E. B. Daskalakis, G. Geralis, T. and Kesisoglou, S. Kyriakis, A. Loukas, D. Manolakos, I. and Markou, A. Markou, C. Mavrommatis, C. Ntomari, E. and Petrakou, E. Gouskos, L. Mertzimekis, T. J. Panagiotou, A. and Saoulidou, N. Stiliaris, E. Evangelou, I. Foudas, C. and Kokkas, P. Manthos, N. Papadopoulos, I. Patras, V. and Triantis, F. A. Aranyi, A. Bencze, G. Boldizsar, L. and Hajdu, C. Hidas, P. Horvath, D. Kapusi, A. Krajczar, K. and Sikler, F. Veres, G. I. Vesztergombi, G. Beni, N. and Molnar, J. Palinkas, J. Szillasi, Z. Veszpremi, V. and Raics, P. Trocsanyi, Z. L. Ujvari, B. Beri, S. B. and Bhatnagar, V. Dhingra, N. Gupta, R. Jindal, M. Kaur, M. and Kohli, J. M. Mehta, M. Z. Nishu, N. Saini, L. K. and Sharma, A. Singh, A. P. Singh, J. Singh, S. P. Ahuja, S. and Choudhary, B. C. Gupta, P. Kumar, A. Kumar, A. and Malhotra, S. Naimuddin, M. Ranjan, K. Shivpuri, R. K. and Banerjee, S. Bhattacharya, S. Dutta, S. Gomber, B. Jain, S. Jain, S. Khurana, R. Sarkar, S. Choudhury, R. K. and Dutta, D. Kailas, S. Kumar, V. Mehta, P. Mohanty, A. K. and Pant, L. M. Shukla, P. Aziz, T. Guchait, M. Gurtu, A. Maity, M. Majumder, D. Majumder, G. Mathew, T. and Mazumdar, K. Mohanty, G. B. Saha, A. Sudhakar, K. and Wickramage, N. Banerjee, S. Dugad, S. Mondal, N. K. and Arfaei, H. Bakhshiansohi, H. Etesami, S. M. Fahim, A. and Hashemi, M. Hesari, H. Jafari, A. Khakzad, M. Mohammadi, A. Najafabadi, M. Mohammadi Mehdiabadi, S. Paktinat and Safarzadeh, B. Zeinali, M. Abbrescia, M. Barbone, L. and Calabria, C. Colaleo, A. Creanza, D. De Filippis, N. De Palma, M. Fiore, L. Iaselli, G. Lusito, L. Maggi, G. and Maggi, M. Manna, N. Marangelli, B. My, S. Nuzzo, S. and Pacifico, N. Pierro, G. A. Pompili, A. Pugliese, G. and Romano, F. Roselli, G. Selvaggi, G. Slivestris, L. and Trentadue, R. Tupputi, S. Zito, G. Abbiendi, G. and Benvenuti, A. C. Bonacorsi, D. Braibant-Giacomelli, S. and Brigliadori, L. Capiluppi, P. Castro, A. Cavallo, F. R. and Cuffiani, M. Dallavalle, G. M. Fabbri, F. Fanfani, A. and Fasanella, D. Giacomelli, P. Giunta, M. Grandi, C. and Marcellini, S. Masetti, G. Meneghelli, M. Montanari, A. and Navarria, F. L. Odorici, F. Perrotta, A. Primavera, F. and Rossi, A. M. Rovelli, T. Siroli, G. Travaglini, R. and Albergo, S. Cappello, G. Chiorboli, M. Costa, S. and Potenza, R. Tricomi, A. Tuve, C. Barbagli, G. Ciulli, V. and Civinini, C. D'Alessandro, R. Focardi, E. Frosali, S. and Gallo, E. Gonzi, S. Lenzi, P. Meschini, M. Paoletti, S. Sguazzoni, G. Tropiano, A. Benussi, L. Bianco, S. and Colafranceschi, S. Fabbri, F. Piccolo, D. Fabbricatore, P. and Musenich, R. Benaglia, A. De Guio, F. Di Matteo, L. and Gennai, S. Ghezzi, A. Malvezzi, S. Martelli, A. and Massironi, A. Menasce, D. Moroni, L. Paganoni, M. and Pedrini, D. Ragazzi, S. Redaelli, N. Sala, S. de Fatis, T. Tabarelli Buontempo, S. Montoya, C. A. Carrillo Cavallo, N. De Cosa, A. Fabozzi, F. Buontempo, S. Iorio, A. O. M. and Lista, L. Merola, M. Paolucci, P. Azzi, P. and Bacchetta, N. 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Barnett, B. A. Blumenfeld, B. Bonato, A. Eskew, C. Fehling, D. Giurgiu, G. Gritsan, A. V. and Guo, Z. J. Hu, G. Maksimovic, P. Rappoccio, S. Swartz, M. Iran, N. V. Whitbeck, A. Baringer, P. Bean, A. and Benelli, G. Grachov, O. Iii, R. P. Kenny Murray, M. and Noonan, D. Sanders, S. Wood, J. S. Zhukova, V. Barfuss, A. F. Bolton, T. Chakaberia, I. Ivanov, A. Khalil, S. and Makouski, M. Maravin, Y. Shrestha, S. Svintradze, I. and Wan, Z. Gronberg, J. Lange, D. Wright, D. Baden, A. and Boutemeur, M. Eno, S. C. Ferencek, D. Gomez, J. A. and Hadley, N. J. Kellogg, R. G. Kim, M. Lu, Y. Mignerey, A. C. Rossato, K. Rumerio, P. Santanastasio, F. Skuja, A. and Temple, J. Tonjes, M. B. Tonwar, S. C. Twedt, E. and Alver, B. Bauer, G. Bendavid, J. Busza, W. Butz, E. and Cali, I. A. Chan, M. Dutta, V. Everaerts, P. Ceballos, G. Gomez Goncharov, M. Hahn, K. A. Harris, P. Kim, Y. and Klute, M. Lee, Y-J. Li, W. Loizides, C. Luckey, P. D. Ma, T. Nahn, S. Paus, C. Ralph, D. Roland, C. and Roland, G. Rudolph, M. Stephans, G. S. F. Stoeckli, F. and Sumorok, K. Sung, K. Velicanu, D. Wenger, E. A. Wolf, R. and Xie, S. Yang, M. Yilmaz, Y. Yoon, A. S. Zanetti, M. and Cooper, S. I. Cushman, P. Dahmes, B. De Benedetti, A. and Franzoni, G. Gude, A. Haupt, J. Klapoetke, K. and Kubota, Y. Mans, J. Pastika, N. Rekovic, V. Rusack, R. and Sasseville, M. Singovsky, A. Tambe, N. Turkewitz, J. and Cremaldi, L. M. Godang, R. Kroeger, R. Perera, L. and Rahmat, R. Sanders, D. A. Summers, D. Bloom, K. Bose, S. and Butt, J. Claes, D. R. Dominguez, A. Eads, M. Jindal, P. Keller, J. Kelly, T. Kravchenko, I. Lazo-Flores, J. and Malbouisson, H. Malik, S. Snow, G. R. Baur, U. and Godshalk, A. Iashvili, I. Jain, S. Kharchilava, A. and Kumar, A. Shipkowski, S. P. Smith, K. Alverson, G. and Barberis, E. Baumgartel, D. Boeriu, O. Chasco, M. and Reucroft, S. Swain, J. Trocino, D. Wood, D. Zhang, J. and Anastassov, A. Kubik, A. Mucia, N. Odell, N. and Ofierzynski, R. A. Pollack, B. Pozdnyakov, A. Schmitt, M. and Stoynev, S. Velasco, M. Won, S. Antonelli, L. Berry, D. Brinkerhoff, A. Hildreth, M. Jessop, C. Karmgard, D. J. Kolb, J. Kolberg, T. Lannon, K. Luo, W. Lynch, S. and Marinelli, N. Morse, D. M. Pearson, T. Ruchti, R. and Slaunwhite, J. Valls, N. Wayne, M. Ziegler, J. Bylsma, B. Durkin, L. S. Gu, J. Hill, C. Killewald, P. and Kotov, K. Ling, T. Y. Rodenburg, M. Vuosalo, C. and Williams, G. Adam, N. Berry, E. Elmer, P. Gerbaudo, D. and Halyo, V. Hebda, P. Hunt, A. Laird, E. Pegna, D. Lopes Marlow, D. Medvedeva, T. Mooney, M. Olsen, J. and Piroue, P. Quan, X. Safdi, B. Saka, H. Stickland, D. and Tully, C. Werner, J. S. Zuranski, A. Acosta, J. G. and Huang, X. T. Lopez, A. Mendez, H. Oliveros, S. Vargas, J. E. Ramirez Zatserklyaniy, A. Alagoz, E. Barnes, V. E. and Bolla, G. Borrello, L. Bortoletto, D. De Mattia, M. and Everett, A. Garfinkel, A. F. Gutay, L. Hu, Z. Jones, M. and Koybasi, O. Kress, M. Laasanen, A. T. Leonardo, N. and Liu, C. Maroussov, V. Merkel, P. Miller, D. H. and Neumeister, N. Shipsey, I. Silvers, D. Svyatkovskiy, A. and Marono, M. Vidal Yoo, H. D. Zablocki, J. Zheng, Y. and Guragain, S. Parashar, N. Adair, A. Boulahouache, C. and Ecklund, K. M. Geurts, F. J. M. Padley, B. P. Redjimi, R. and Roberts, J. Zabel, J. Betchart, B. Bodek, A. Chung, Y. S. Covarelli, R. de Barbaro, P. Demina, R. Eshaq, Y. and Flacher, H. Garcia-Bellido, A. Goldenzweig, P. Gotra, Y. and Han, J. Harel, A. Miner, D. C. Petrillo, G. and Sakumoto, W. Vishnevskiy, D. Zielinski, M. Bhatti, A. and Ciesielski, R. Demortier, L. Goulianos, K. Lungu, G. and Malik, S. Mesropian, C. Arora, S. Atramentov, O. Barker, A. Contreras-Campana, C. Contreras-Campana, E. Duggan, D. and Gershtein, Y. Gray, R. Halkiadakis, E. Hidas, D. and Hits, D. Lath, A. Panwalkar, S. Patel, R. Richards, A. and Rose, K. Schnetzer, S. Somalwar, S. Stone, R. and Thomas, S. Cerizza, G. Hollingsworth, M. Spanier, S. and Yang, Z. C. York, A. Eusebi, R. Flanagan, W. Gilmore, J. and Gurrola, A. Kamon, T. Khotilovich, V. Montalvo, R. and Osipenkov, I. Pakhotin, Y. Perloff, A. Safonov, A. and Sengupta, S. Suarez, I. Tatarinov, A. Toback, D. and Akchurin, N. Bardak, C. Damgov, J. Dudero, P. R. Jeong, C. Kovitanggoon, K. Lee, S. W. Libeiro, T. Mane, P. and Roh, Y. Sill, A. Volobouev, I. Wigmans, R. Yazgan, E. and Appelt, E. Brownson, E. Engh, D. Florez, C. Gabella, W. Issah, M. Johns, W. Johnston, C. Kurt, P. and Maguire, C. Melo, A. Sheldon, P. Snook, B. Tuo, S. and Velkovska, J. Arenton, M. W. Balazs, M. Boutle, S. Cox, B. Francis, B. Goadhouse, S. Goodell, J. Hirosky, R. and Ledovskoy, A. Lin, C. Neu, C. Wood, J. Yohay, R. and Gollapinni, S. Harr, R. Karchin, P. E. Don, C. Kottachchi Kankanamge Lamichhane, P. Mattson, M. Milstene, C. and Sakharov, A. Anderson, M. Bachtis, M. Belknap, D. and Bellinger, J. N. Carlsmith, D. Cepeda, M. Dasu, S. and Efron, J. Gray, L. Grogg, K. S. Grothe, M. Hall-Wilton, R. Herndon, M. Herve, A. Klabbers, P. Klukas, J. and Lanaro, A. Lazaridis, C. Leonard, J. Loveless, R. and Mohapatra, A. Ojalvo, I. Parker, W. Ross, I. Savin, A. and Smith, W. H. Swanson, J. Weinberg, M. CMS Collaboration

Subjects
Physics::Instrumentation and Detectors, High Energy Physics::Phenomenology, High Energy Physics::Experiment, Nuclear Experiment
Abstract

A measurement is presented of the charged hadron multiplicity in hadronic PbPb collisions, as a function of pseudorapidity and centrality, at a collision energy of 2.76 TeV per nucleon pair. The data sample is collected using the CMS detector and a minimum-bias trigger, with the CMS solenoid off. The number of charged hadrons is measured both by counting the number of reconstructed particle hits and by forming hit doublets of pairs of layers in the pixel detector. The two methods give consistent results. The charged hadron multiplicity density, dN(ch)/d eta vertical bar(eta=0), for head-on collisions is found to be 1612 +/- 55, where the uncertainty is dominated by systematic effects. Comparisons of these results to previous measurements and to various models are also presented.

Published
2011

26. Papillary muscle rupture and pericardial injuries after blunt chest trauma

Author

Giuseppe Bruschi, Ettore Vitali, Fiore S. Iorio, and Salvatore Agati

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, Heart Injury, medicine.medical_specialty, Thoracic Injuries, medicine.medical_treatment, Wounds, Nonpenetrating, Blunt, Internal medicine, Mitral valve, medicine, Humans, Pericardium, cardiovascular diseases, Papillary muscle, Heart Valve Prosthesis Implantation, Rupture, Mitral regurgitation, business.industry, Mitral valve replacement, General Medicine, Papillary Muscles, medicine.disease, Surgery, medicine.anatomical_structure, Heart Injuries, Heart failure, cardiovascular system, Cardiology, Mitral Valve, Cardiology and Cardiovascular Medicine, business
Abstract

Non-penetrating cardiac trauma resulting in mitral valve rupture is uncommon, requiring a high degree of suspicion for diagnosis. Sudden and severe mitral regurgitation, unless surgically corrected rapidly lead to congestive heart failure and death. We report a patient with traumatic rupture of the antero-lateral papillary muscle of the mitral valve and pericardial injury, after a lateral blunt chest trauma, who successfully underwent emergency mitral valve replacement.

Published
2001
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27. Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair

Author

Roberta Iacobelli, Duccio Di Carlo, Guido Michielon, Sergio Filippelli, Gianluca Oricchio, Gianluca Brancaccio, Antonio Amodeo, Roberto M. Di Donato, Fiore S. Iorio, and Gianluigi Perri

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Complete atrioventricular septal defect, Heart disease, Adolescent, Prosthesis Implantation, Internal medicine, Medicine, Ventricular outflow tract, Humans, cardiovascular diseases, Cardiac Surgical Procedures, Child, Tetralogy of Fallot, Retrospective Studies, Pulmonary Valve, business.industry, Heart Septal Defects, Infant, Settore MED/23 - Chirurgia Cardiaca, Prostheses and Implants, medicine.disease, Surgery, medicine.anatomical_structure, Pulmonary valve, Child, Preschool, Circulatory system, Cardiology, cardiovascular system, Female, Transannular patch, business, Cardiology and Cardiovascular Medicine, Artery
Abstract

Objective We report our experience with repair of tetralogy of Fallot associated with complete atrioventricular septal defect, addressing in particular the need for a pulmonary valve in the right ventricular outflow tract. Methods Between 1992 and 2006, 33 children with tetralogy of Fallot and complete atrioventricular septal defect were admitted; 26 had Down's syndrome (79%). Thirty-two children had complete repair (18 primary, 14 staged); of the 15 who received initial palliation, 1 died before complete repair. Right ventricular outflow tract obstruction was relieved by transannular patch in 14 cases (42%), infundibular patch with preservation of the pulmonary valve in 7 (21%), and right ventricle–to–pulmonary artery conduit in 11 (33%). Results There were no hospital deaths. Actuarial survival was 96% ± 3.9% at 5 years and 85.9 ± 1.1% at 10 years. Multivariate analysis showed that type of relief of right ventricular outflow tract obstruction did not influence survival ( P = .16), nor did the choice to use a valved conduit ( P = .82). Primary correction ( P = .05) and lower weight at repair ( P = .05) were associated with higher probability of survival. Mean follow-up was 69.3 ± 5.9 months (range 0.2–282 months). There were 2 late deaths. Overall freedom from reoperation was 69% at 5 years and 38% at 10 years. Right ventricular outflow tract reconstruction without use of a valved conduit allowed a significantly higher freedom from reinterventions ( P Conclusions Tetralogy of Fallot associated with complete atrioventricular septal defect can be corrected at low risk with favorable intermediate survival. Use of right ventricle–to–pulmonary artery conduit can be avoided in two thirds of patients with no impact on survival, possibly improving overall freedom from reintervention.

Published
2008

28. The effect of maternal hypothermic cardiopulmonary bypass on fetal lamb temperature, hemodynamics, oxygenation, and acid-base balance

Author

Irene Cetin, Nicola Berlanda, Veronica Boero, Francesco Santoro, Fabio Acocella, Giorgio Pardi, Fiore S. Iorio, Maria Maddalena Ferrari, Claudio Reato, and Ario Monaco

Subjects
Pulmonary and Respiratory Medicine, Alkalosis, Hemodynamics, Sensitivity and Specificity, law.invention, Body Temperature, Oxygen Consumption, law, Hypothermia, Induced, Pregnancy, Heart rate, medicine, Cardiopulmonary bypass, Animals, Fetal Monitoring, Fetal Death, Maternal-Fetal Exchange, Acid-Base Equilibrium, Cardiopulmonary Bypass, Sheep, business.industry, Pulmonary Gas Exchange, Hypothermia, medicine.disease, Fetal Tachycardia, Blood pressure, Anesthesia, Circulatory system, embryonic structures, Pregnancy, Animal, Surgery, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Objective To evaluate fetal–maternal temperature relationship and fetal cardiovascular and metabolic response during maternal hypothermic cardiopulmonary bypass in pregnant ewes. Methods Cardiopulmonary bypass was instituted in 9 pregnant ewes, reaching 2 different levels of maternal hypothermia: 24°C to 20°C (deep hypothermia) in group A (5 cases) and less than 20°C (very deep hypothermia) in group B (4 cases). Hypothermic levels were maintained for 20 minutes, then the rewarming phase was started. Fetal and maternal temperature, blood pressure, heart rate, electrocardiogram, blood gases, and acid–base balance were evaluated at different levels of hypothermia and during recovery. Results Fetal survival was related to maternal hypothermia: all group A fetuses survived, while 2 of 4 fetuses of group B in which maternal temperature was lowered below 18°C died in a very deep acidotic and hypoxic status. Maternal temperature was always lower than fetal temperature during cooling; during rewarming the gradient was inverted. The start of cardiopulmonary bypass and cooling was associated with transient fetal tachycardia and hypertension; then, both fetal heart rate and blood pressure progressively decreased. The reduction of fetal heart rate was of 7 beats per minute for each degree of fetal cooling. Deep maternal hypothermia was associated with fetal alkalosis and reduction of P o 2. Very deep hypothermia, in particular below 18°C, caused irreversible fetal acidosis and hypoxia. Conclusions Deep maternal hypothermic cardiopulmonary bypass was associated with reversible modifications in fetal cardiovascular parameters, blood gases, and acid–base balance and therefore with fetal survival. On the contrary, fetuses did not survive to a very deep hypothermia below 18°C.

Published
2004

30. Shelhigh No-React porcine pulmonic valve conduit: a new alternative to the homograft

Author

Fiore S. Iorio, Gabriele M. Iacona, Claudia Condoluci, Francesco Seddio, Carlo Marcelletti, Stefano M. Marianeschi, Shlomo Gabbay, Raul Abella, and Adriano Cipriani

Subjects
Pulmonary and Respiratory Medicine, Aortic valve disease, Adult, Heart Defects, Congenital, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Rastelli Operation, Pulmonary Artery, Prosthesis Design, Ventricular Outflow Obstruction, Blood Vessel Prosthesis Implantation, Electrical conduit, Internal medicine, medicine, Ventricular outflow tract, Humans, Child, Bioprosthesis, Heart Valve Prosthesis Implantation, Pulmonary Valve, business.industry, Ross procedure, Infant, Mean age, medicine.disease, Surgery, Echocardiography, Child, Preschool, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Calcification, Follow-Up Studies
Abstract

Background . The Shelhigh No-React pulmonic valve conduit is a new porcine conduit that is glutaraldehyde-treated and detoxified using a proprietary heparin process. In our institution it has been implanted in 25 patients. The aim of this present contribution is to evaluate the short-term follow-up after its implantation. Methods . From November 1997 to August 1999, 25 patients (mean age, 20.2 years; range, 0.6 to 28.3 years) were operated on using this conduit. Seventeen patients underwent a Ross procedure for aortic valve disease, with the conduits implanted in anatomic position; 6 patients underwent right ventricular outflow tract reconstruction; 2 patients underwent the Rastelli operation. The follow-up was complete. Preoperative and postoperative two-dimensional echocardiography data were collected. Results . There were two non–conduit-related deaths. Two conduits needed to be exchanged because of an increase in the gradient. Overall, all patients were improved in terms of New York Heart Association class. Comparison of preoperative and postoperative two-dimensional echocardiography gradient showed significant improvement. At the 30-month follow-up, no calcification was seen on the explanted conduits or on the two-dimensional echocardiography, although many of the patients are children. Conclusions . The Shelhigh conduits seem to be an alternative to homograft especially in infants. These experiences are preliminary, and longer follow-up is required.

Published
2001

31. Combined Mustard and Rastelli operations

Author

R. Di Donato, Adriano Carotti, Carlos J. Troconis, Bruno Marino, E Rossi, Fiore S. Iorio, and Carlo Marcelletti

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Heart septal defect, Aorta, business.industry, medicine.disease, Ventriculotomy, Surgery, Situs inversus, medicine.anatomical_structure, Ventricle, Great arteries, medicine.artery, Pulmonary artery, cardiovascular system, medicine, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Situs solitus
Abstract

We report on two patients with congenitally corrected transposition of the great arteries in situs inversus who underwent successful anatomic repair of associated cardiac anomalies--ventricular septal defect and pulmonary outflow tract obstruction. Surgical intervention was influenced by the recently introduced technique of Ilbawi and colleagues in cases of congenitally corrected transposition in situs solitus. Principles of the correction are as follows: (1) patch redirection of venous flows at the atrial level through an incision in the left-sided right atrium; (2) patch closure of the ventricular septal defect through a right ventriculotomy, baffling the left ventricle to the aorta; and (3) valved conduit interposition between the right ventricle and the pulmonary artery. If the ventricular septal defect is restrictive, it can be safely enlarged by extensive resection of the anterosuperior border, because of the posteroinferior location of the bundle of His in this anomaly. With this technique, the left ventricle and the native mitral and aortic valves are recruited for systemic work, with intrinsic long-term advantages. It is, however, a complex procedure involving substantial use of prosthetic material. More experience is necessary to establish whether this approach is superior to currently available physiologic repairs.

Published
1992
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34. S100 blood concentrations in children subjected to cardiopulmonary by-pass

Author

Fiore S. Iorio, Fabrizio Michetti, Maria Concetta Geloso, Carlo Marcelletti, Paola Vinesi, Stefano M. Marianeschi, Adriano Cipriani, and Diego Gazzolo

Subjects
Nervous system, Male, Pathology, medicine.medical_specialty, Heart Diseases, Clinical Biochemistry, Physiology, Hemodynamics, Disease, S100B, medicine, Humans, Child, Pathological, Monitoring, Physiologic, Cardiopulmonary Bypass, business.industry, Nervous tissue, Biochemistry (medical), Extracorporeal circulation, S100 Proteins, Infant, Newborn, Infant, Cardiac surgery, Distress, medicine.anatomical_structure, Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, Biological fluids, Child, Preschool, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Female, business, Cardiopulmonary By-Pass
Abstract

S100 is a member of a family of calcium-binding proteins present primarily in nervous tissue, where it is mainly concentrated in glial cells (1)(2). Although the role of this protein in brain function and disease has not yet been conclusively elucidated, it has been ascertained that the appearance of this protein constituent of neural cells in biological fluids is a reliable indicator of active cell damage in the nervous system in different pathological conditions (3)(4)(5)(6). Open heart surgery is known to be associated with brain cell injury. It was diagnosed previously using rather crude psychometric tests and clinical observations in seemingly healthy patients (7), and measurements of S100 in the blood have recently been successfully used to monitor cerebral damage after cardiac surgery (8)(9)(10). The present study is aimed at investigating the potential use of measurements of S100 in the blood to monitor possible cerebral distress during extracorporeal circulation in children (0–9 years), when hemodynamic adaptive phenomena in the brain show peculiarities linked to the age of the patient (11). The data presented indicate significantly higher blood concentrations of this nervous tissue constituent during cardiopulmonary by-pass (CPB), together with a direct relationship with the duration of CPB. Blood samples were taken from 13 patients (6 males and 7 females), ages from

Published
1998

35. Neonatal pulmonary autograft implantation for cardiac tumor involving aortic valve

Author

Salvatore Giannico, Adriano Carotti, C. Squitieri, Sergio Picardo, Carlo Marcelletti, Antonio Amodeo, Fiore S. Iorio, and Alessandro Giamberti

Subjects
Pulmonary and Respiratory Medicine, Aortic valve, Male, medicine.medical_specialty, Rhabdomyoma, Transplantation, Autologous, Heart Neoplasms, Internal medicine, medicine, Ventricular outflow tract, Humans, cardiovascular diseases, Cardiac Tumors, Pulmonary Valve, business.industry, Left atrioventricular junction, Infant, Newborn, Aortic Valve Stenosis, medicine.disease, Surgery, Transplantation, medicine.anatomical_structure, Pulmonary valve, Aortic Valve, cardiovascular system, Ventricular pressure, Cardiology, Cardiology and Cardiovascular Medicine, business
Abstract

We diagnosed in a 4-day-old neonate a cardiac tumor involving the left atrium, left atrioventricular junction, left ventricular outflow tract, and aortic valve with severe subvalvular and valvular aortic stenosis. The critical involvement of the aortic valve and the scarcity of neonatal cardiac donors led us to perform a successful replacement of the aortic root with a pulmonary autograft, using a very small homograft for the native pulmonary valve (Ross operation).

Published
1995

36. Impact of DEL22q11, trisomy 21, and other genetic syndromes on surgical outcome of conotruncal heart defects

Author

Sergio Filippelli, Fiore S. Iorio, Maria Cristina Digilio, Silvia Placidi, Bruno Marino, Roberto M. Di Donato, Gianluca Oricchio, and Guido Michielon

Subjects
Heart Defects, Congenital, Male, Reoperation, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Down syndrome, Chromosomes, Human, Pair 22, law.invention, law, Risk Factors, Internal medicine, Conotruncal defect, medicine, Humans, Abnormalities, Multiple, Survival rate, Tetralogy of Fallot, Cause of death, Retrospective Studies, business.industry, Cardiovascular Surgical Procedures, Infant, Newborn, Infant, Retrospective cohort study, Settore MED/23 - Chirurgia Cardiaca, Syndrome, medicine.disease, Intensive care unit, Surgery, Survival Rate, Treatment Outcome, Female, Chromosome Deletion, Down Syndrome, Trisomy, business, Cardiology and Cardiovascular Medicine, Follow-Up Studies
Abstract

ObjectiveGenetic syndromes occur in more than 20% of patients with conotruncal heart defects. We investigated the impact of genetic syndromes on the surgical outcome of conotruncal anomalies in infancy.MethodsThis retrospective study reviews the outcome of 787 patients (median age 6.3 months) who underwent primary (598) or staged (189) repair of a conotruncal defect between 1992 and 2007.ResultsProven genetic syndrome was diagnosed in 211 patients (26.8%), including del22q11 (91 patients), trisomy 21 (29 patients), VACTERL (18 patients), and other syndromes (73 patients). Primary repair was accomplished in 80.9% of nonsyndromic patients and 74.4% of syndromic patients (P = .18) Fifteen-year cumulative survival was 84.3% ± 2.3% in nonsyndromic patients and 73.2% ± 4.2% in syndromic patients (P < .001). Primary and staged repair allowed similar 15-year survival (81.4% ± 4.5% vs 79.1% ± 5.1%, P = .8). Freedom from noncardiac cause of death was significantly lower in syndromic patients (P = .0056). Fifteen-year Kaplan–Meier survival was 87.6% ± 3.9% for del22q11, 95.8% ± 4.1% for trisomy 21, 56.8% ± 6.3% for VACTERL, and 62.3% ± 12.7% for patients with other syndromes (P = .022). Total intensive care unit stay was 10.8 ± 4.9 days in syndromic patients and 5.1 ± 1.7 days in nonsyndromic patients (P < .001). Freedom from reintervention 15 years after repair was 79.6% ± 4.9% in nonsyndromic patients and 62.4% ± 7.4% in syndromic patients (P = .007).ConclusionDel22q11 and trisomy 21 do not represent risk factors for mortality after repair of conotruncal anomalies, whereas other syndromes adversely affect the surgical outcome for predominant noncardiac attrition. Higher morbidity and lower mid-term freedom from reintervention can be predicted in syndromic patients.

Published
2009
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37. Reversal of protein-losing enteropathy after ligation of systemic-pulmonary shunt

Author

Stefano M. Marianeschi, Paolo Masetti, Fiore S. Iorio, Adriano Cipriani, and Carlo Marcelletti

Subjects
Adult, Pulmonary and Respiratory Medicine, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Heart disease, Protein-Losing Enteropathies, medicine.medical_treatment, Vena Cava, Inferior, Pulmonary Artery, Fontan Procedure, Coronary Circulation, Ascites, medicine, Humans, Enteropathy, Ligature, Ligation, business.industry, Protein losing enteropathy, medicine.disease, Surgery, Shunt (medical), Regional Blood Flow, Pulmonary shunt, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

A 21-year-old white woman, born with a univentricular heart, had undergone staged procedures before Fontan correction. She then began to develop edema, protein-losing enteropathy, and ascites refractory to diuretic therapy. Cardiac angiography showed a patent right Blalock-Taussig shunt, with turbulent cavopulmonary circulation. After undergoing an unsuccessful attempt at coil embolization she then underwent shunt ligation, with resolution of symptoms and normalization of protein levels. This report draws attention to the importance of cavopulmonary laminar flow to prevent the development of protein-losing enteropathy.

Published
1999
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38. Total cavopulmonary direct anastomosis: A logical approach in selected patients

Author

Duccio C. di Carlo, Giuseppe De Simone, Adriano Carotti, Simonetta Nava, Stefano M. Marianeschi, Antonio Amodeo, Alessandro Giamberti, Fiore S. Iorio, and Carlo Marcelletti

Subjects
Heart Defects, Congenital, Male, Pulmonary and Respiratory Medicine, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Vena Cava, Superior, Pulmonary Artery, Anastomosis, Inferior vena cava, Arteriovenous Shunt, Surgical, Superior vena cava, medicine.artery, medicine, Humans, Abnormalities, Multiple, cardiovascular diseases, Tricuspid atresia, business.industry, medicine.disease, Surgery, Stenosis, medicine.anatomical_structure, medicine.vein, Great arteries, Child, Preschool, Pulmonary artery, cardiovascular system, Radiology, Cardiology and Cardiovascular Medicine, business, Situs solitus
Abstract

A 2.5-year-old boy with a diagnosis of situs solitus, tricuspid atresia, anatomically corrected malposition of the great arteries (S,D,L), left juxtaposition of atrial appendages, and pulmonary stenosis underwent successful total cava-to-pulmonary connection by means of a superior vena cava-to-pulmonary artery end-to-side anastomosis associated with an inferior vena cava-to-pulmonary artery direct anastomosis. Anatomic features and surgical technique are described.

Published
1993
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39. Consensus statement on hypoplastic and rudimentary ventricles: morphology, angiography, and echocardiography

Author

Fiore S. Iorio and Carlo Marcelletti

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Heart disease, medicine.diagnostic_test, business.industry, Statement (logic), Morphology (biology), medicine.disease, Hypoplasia, Surgery, Angiography, Medicine, Radiology, Congenital disease, Cardiology and Cardiovascular Medicine, business
Published
1998
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40. A benchmark study on the thermal conductivity of nanofluids

Author

Thirumalachari Sundararajan, Gang Chen, Lim Geok Kieng, Wei Hsun Yeh, Jacopo Buongiorno, Pawel Keblinski, Aleksandr N. Turanov, Frank Dubois, Sheng-Qi Zhou, Jinwei Gao, Seung-Hyun Lee, Jacob Eapen, Anselmo Cecere, Mark Horton, Carlo Saverio Iorio, Haiping Hong, Yun Chang, Denis Funfschilling, Marco Bonetti, Stefan Van Vaerenbergh, Sung Jae Chung, Thomas J. McKrell, Chongyoup Kim, Pengxiang Song, John Philip, Yulong Ding, Patricia E. Gharagozloo, Jorge L. Alvarado, Sanjeeva Witharana, Xiao Zheng Zhao, Seok Pil Jang, Seokwon Kim, Jorge Gustavo Gutierrez, Sandra Whaley Bishnoi, Elena V. Timofeeva, Pawan Singh, Mark A. Kedzierski, Quentin Galand, Rui Ni, Sarit K. Das, Kenneth E. Goodson, Aravind Kamath, Raffaele Savino, Bruno Michel, Minking K. Chyu, Grzegorz Dzido, Dongsheng Wen, Yiran Jiang, Kai Choong Leong, Roberto Di Paola, Rebecca Christianson, Haisheng Chen, Werner Escher, In Cheol Bang, Jessica Townsend, Kyo Sik Hwang, Yuriy V. Tolmachev, Naveen Prabhat, Todd Tritcak, Chun Yang, Stephan Kabelac, Cécile Reynaud, Dimos Poulikakos, Indranil Manna, Frank Botz, Ji Hyun Kim, Liwen Jin, David C. Venerus, Hrishikesh E. Patel, Lin-Wen Hu, Andrzej B. Jarzębski, Jacopo, Buongiorno, David C., Veneru, Naveen, Prabhat, Thomas, Mckrell, Jessica, Townsend, Rebecca, Christianson, Yuriy V., Tolmachev, Pawel, Keblinski, Lin wen, Hu, Jorge L., Alvarado, In Cheol, Bang, Sandra W., Bishnoi, Marco, Bonetti, Frank, Botz, Cecere, Anselmo, Yun, Chang, Gang, Chen, Haisheng, Chen, Sung Jae, Chung, Minking K., Chyu, Sarit K., Da, Roberto Di, Paola, Yulong, Ding, Frank, Duboi, Grzegorz, Dzido, Jacob, Eapen, Werner, Escher, Denis, Funfschilling, Quentin, Galand, Jinwei, Gao, Patricia E., Gharagozloo, Kenneth E., Goodson, Jorge Gustavo, Gutierrez, Haiping, Hong, Mark, Horton, Kyo Sik, Hwang, Carlo S., Iorio, Seok Pil, Jang, Andrzej B., Jarzebski, Yiran, Jiang, Liwen, Jin, Stephan, Kabelac, Aravind, Kamath, Mark A., Kedzierski, Lim Geok, Kieng, Chongyoup, Kim, Ji Hyun, Kim, Seokwon, Kim, Seung Hyun, Lee, Kai Choong, Leong, Indranil, Manna, Bruno, Michel, Rui, Ni, Hrishikesh E., Patel, John, Philip, Dimos, Poulikako, Cecile, Reynaud, Savino, Raffaele, Pawan K., Singh, Pengxiang, Song, Thirumalachari, Sundararajan, Elena, Timofeeva, Todd, Tritcak, Aleksandr N., Turanov, Stefan Van, Vaerenbergh, Dongsheng, Wen, Sanjeeva, Witharana, Chun, Yang, Wei Hsun, Yeh, Xiao Zheng, Zhao, and Sheng Qi, Zhou

Subjects
Materials science, Transient hot wire method, Thermal conductivity of liquids, Oxide, Data analysis, General Physics and Astronomy, Nanoparticle, Thermodynamics, Optical conductivity, Nanofluidics, Nanotechnology, Experimental data, Metal, Elongated particles, Nanofluids, chemistry.chemical_compound, Viscosity, Thermal conductivity, Nanofluid, Metallic compounds, heat transfer, Benchmark study, Classical theory, Narrow bands, Steady-state method, Sample average, Absolute values, Nano-fluid, Optical properties, Optical methods, Stable dispersions, Dispersed p Effective medium theories, Thermoanalysis, Data handling, Non-aqueous, Aspect ratio, Particle concentrations, chemistry, visual_art, visual_art.visual_art_medium, Particle, nanofluid, Experimental approaches, Metal oxide particles
Abstract

This article reports on the International Nanofluid Property Benchmark Exercise, or INPBE, in which the thermal conductivity of identical samples of colloidally stable dispersions of nanoparticles or "nanofluids," was measured by over 30 organizations worldwide, using a variety of experimental approaches, including the transient hot wire method, steady-state methods, and optical methods. The nanofluids tested in the exercise were comprised of aqueous and nonaqueous basefluids, metal and metal oxide particles, near-spherical and elongated particles, at low and high particle concentrations. The data analysis reveals that the data from most organizations lie within a relatively narrow band (�10% or less) about the sample average with only few outliers. The thermal conductivity of the nanofluids was found to increase with particle concentration and aspect ratio, as expected from classical theory. There are (small) systematic differences in the absolute values of the nanofluid thermal conductivity among the various experimental approaches; however, such differences tend to disappear when the data are normalized to the measured thermal conductivity of the basefluid. The effective medium theory developed for dispersed particles by Maxwell in 1881 and recently generalized by Nan [J. Appl. Phys. 81, 6692 (1997)], was found to be in good agreement with the experimental data, suggesting that no anomalous enhancement of thermal conductivity was achieved in the nanofluids tested in this exercise. � 2009 American Institute of Physics.

Published
2009

42. A longitudinal study of vasopressin cell antibodies, posterior pituitary function, and magnetic resonance imaging evaluations in subclinical autoimmune central diabetes insipidus

Author

G. Lombardi, Antonio Bizzarro, Antonio Bellastella, Silvia Perrino, Concetta Coronella, A. Colao, F. Di Salle, Rosario Pivonello, A. De Bellis, V. I. Muccitelli, Sergio Iorio, DE BELLIS, Annamaria, Colao, A, DI SALLE, F, Muccitelli, Vi, Iorio, S, Perrino, S, Pivonello, R, Coronella, C, Bizzarro, Antonio, Lombardi, G, Bellastella, A., A., De Belli, Colao, Annamaria, DI SALLE, Francesco, V. I., Muccitelli, S., Iorio, S., Perrino, Pivonello, Rosario, C., Coronella, A., Bizzarro, Lombardi, Gaetano, and A., Bellastella

Subjects
Male, Pituitary gland, Vasopressin, genetic structures, analysis, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Biochemistry, Endocrinology, Pituitary Gland, Posterior, autoimmune central diabetes insipidus, Deamino Arginine Vasopressin, Longitudinal Studies, Prospective Studies, Desmopressin, Prospective cohort study, Subclinical infection, posterior pituitary function, Magnetic Resonance Imaging, medicine.anatomical_structure, Pituitary Gland, immunology/physiopathology, Female, medicine.symptom, medicine.drug, Adult, drug therapy/immunology/physiopathology, medicine.medical_specialty, Adolescent, Adult, Autoantibodies, blood, Autoimmune Diseases, immunology/physiopathology, Deamino Arginine Vasopressin, therapeutic use, Diabetes Insipidus, drug therapy/immunology/physiopathology, Female, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Pituitary Gland, Posterior, immunology/pathology/physiopathology, Prospective Studies, Vasopressins, analysis, Water Deprivation, immunology/pathology/physiopathology, Adolescent, Vasopressins, Asymptomatic, Autoimmune Diseases, blood, Posterior pituitary, Internal medicine, medicine, Humans, Autoantibodies, Water Deprivation, business.industry, Biochemistry (medical), vasopressin cell antibodie, medicine.disease, therapeutic use, Diabetes insipidus, business, Diabetes Insipidus
Abstract

Cytoplasmic autoantibodies to vasopressin-cells (AVPcAb) have been detected not only in patients with overt central diabetes insipidus (CDI), but also in patients with endocrine autoimmune diseases without CDI. This suggests that complete CDI can be preceded by a preclinical stage. Among 878 patients with endocrine autoimmune diseases without CDI, 9 patients found to be AVPcAb positive and 139 AVPcAb-negative controls were enrolled in this open prospective study. They were evaluated for AVPcAb and posterior pituitary function at least yearly for about 4 yr (range, 37‐ 48 months); during this span, magnetic resonance imaging (MRI) of posterior pituitary and stalk was performed only in the AVPcAb-positive patients. Five of the 9 AVPcAb-positive patients had normal posterior pituitary function at study entry. They were AVPcAb positive throughout the follow-up period. At later stages of the study, 3 of them developed partial CDI, and 1 developed complete CDI. The remaining 4 patients showed impaired response to the water deprivation test at study entry and were diagnosed as having partial CDI. Two of them agreed to receive desmopressin replacement for 1 yr. After this treatment, the patients became negative for AVPcAb and displayed normal posterior pituitary function until the end of the follow-up. Conversely, the 2 untreated patients with partial CDI remained AVPcAb positive. One of them developed overt CDI. None of the controls became AVPcAb positive or developed CDI. The normal hyperintense MRI signal of the posterior pituitary, present at study entry, persisted subsequently in all 9 AVPcAb-positive patients, including those developing overt CDI, only disappearing in the late phase of complete CDI. In asymptomatic subjects, the monitoring of AVPcAb, but not MRI, seems to be useful to predict a progression toward partial/overt CDI. Early desmopressin therapy in patients with partial CDI could interrupt or delay the autoimmune damage and the progression toward clinically overt CDI. (J Clin Endocrinol Metab 84: 3047‐3051, 1999)

Published
1999

43. Novel Artificial Intelligence-Based Assessment of Imaging Biomarkers in Full-Thickness Macular Holes: Preliminary Data from a Pivotal Trial.

Author

Mariotti C, Mangoni L, Iorio S, Lombardo V, Fruttini D, Rizzo C, Chhablani J, Midena E, and Lupidi M

Abstract

Artificial intelligence (AI)- and deep learning (DL)-based systems have shown significant progress in the field of macular disorders, demonstrating high performance in detecting retinal fluid and assessing anatomical changes during disease progression. This study aimed to validate an AI algorithm for identifying and quantifying prognostic factors in visual recovery after macular hole (MH) surgery by analyzing major optical coherence tomography (OCT) biomarkers. This study included 20 patients who underwent vitrectomy for a full-thickness macular hole (FTMH). The mean diameter of the FTMH was measured at 285.36 ± 97.4 μm. The preoperative best-corrected visual acuity (BCVA) was 0.76 ± 0.06 logMAR, improving to 0.38 ± 0.16 postoperatively, with a statistically significant difference ( p = 0.001). AI software was utilized to assess biomarkers, such as intraretinal fluid (IRF) and subretinal fluid (SRF) volume, external limiting membrane (ELM) and ellipsoid zone (EZ) integrity, and retinal hyperreflective foci (HRF). The AI analysis showed a significant decrease in IRF volume, from 0.08 ± 0.12 mm 3 preoperatively to 0.01 ± 0.01 mm 3 postoperatively. ELM interruption improved from 79% ± 18% to 34% ± 37% after surgery ( p = 0.006), whereas EZ interruption improved from 80% ± 22% to 40% ± 36% ( p = 0.007) postoperatively. Additionally, the study revealed a negative correlation between preoperative IRF volume and postoperative BCVA recovery, suggesting that greater preoperative fluid volumes may hinder visual improvement. The integrity of the ELM and EZ was found to be essential for postoperative visual acuity improvement, with their disruption negatively impacting visual recovery. The study highlights the potential of AI in quantifying OCT biomarkers for managing MHs and improving patient care.

Published
2024
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44. History of medicine in medical education: new Italian pathways.

Author

Iorio S, Gazzaniga V, and Lippi D

Subjects
History of Medicine, Humans, Medicine, Education, Medical
Abstract

Objective: There is little doubt that there are currently obstacles in measuring the impact of the history of medicine within medical training. Consequently, there is a clear need to support a vision that can historicize Euro-Western medicine, leading to a greater understanding of how the medical world is a distinct form of reality for those who are about to immerse themselves in the study of medicine., Methods: History teaches that changes in medicine are due to the processes inherent to the interaction among individuals, institutions, and society rather than individual facts or individual authors., Results: Therefore, we cannot ignore the fact that the expertise and know-how developed during medical training are the final product of relationships and memories that have a historical life that is based social, economic, and political aspects., Conclusion: Moreover, these relationships and memories have undergone dynamic processes of selection and attribution of meaning, as well as individual and collective sharing, which have also been confronted with archetypes that are still able to influence clinical approaches and medical therapy today., (Copyright © 2023 Silvia Iorio, Valentina Gazzaniga, Donatella Lippi.)

Published
2023
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45. Psycho-Emotional Well-Being in Caregivers of People with Acquired Brain Injury: An Exploratory Study on the Human Immersion Model during the Omicron Wave.

Author

De Luca R, Pollicino P, Rifici C, Mondo N, Iorio S, Cassaniti A, Ferrara D, Caminiti A, Famà F, Bonanno M, and Calabrò RS

Abstract

The purpose of this study was to investigate the effects of a "human immersion model" (HIM) in improving psychological well-being in caregivers of patients with acquired brain injury (ABI) during the Omicron wave in Italy. Fifteen subjects affected by ABI, who attended our intensive neurorehabilitation unit from January to March 2022 and their caregivers were submitted to the HIM. This novel approach consisted of "real" long-lasting meetings between the patients and their careers in a hospital setting (1-72 h meeting per week for 8 weeks). Each ABI caregiver was assessed through the administration of a short psychometric battery before starting the first immersion session with their family member and at the end of the HIM. We found significant changes in the caregivers' scores analyzed for anxiety, as per SAS ( p < 0.0007, d = 1.02), burden and stress (ZBI-22; p < 0.001, d = 0.65), and emotive intelligence (TEIQue-SF; p < 0.0007, d = 0.82). Our data suggest that the HIM may be useful to promote ABI caregivers' psycho-emotional well-being in the context of critical periods such as the COVID-19 pandemic.

Published
2023
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46. Measuring Disability among Migrants with Washington Group Tools: Reflections for Field Use.

Author

Tofani M, Galeoto G, Berardi A, Iorio S, Conte A, Fabbrini G, Valente D, and Marceca M

Abstract

Measuring disability among migrants is a significant challenge; however, there is no consensus on how to measure disability and functional limitations. The present study reports a methodological approach to measure disability in refugees and asylum seekers using Washington Group (WG) tools, namely the WG Short Set (WG-SS), the Short Set Enhanced (WG-SS-E), and the Extended Set on Functioning (WG-ES). We interviewed 161 migrants in different regions of Italy. The recommended threshold for each WG tool was used. We identified 13.7% of migrants with disabilities using the WG-SS, 21.7% using the WG-SS-E, and 31.6% using the WG-ES. Anxiety and depression were the main weights to identify migrants with disabilities (11.8%). The WG-SS does not measure mental health, and therefore we do not suggest its use in the field. However, the WG-SS-E, together with some questions on pain and fatigue, should be considered to identify migrants with a greater risk of disability.

Published
2022
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47. Repeat thyroid FNAC: Inter-observer agreement among high- and low-volume centers in Naples metropolitan area and correlation with the EU-TIRADS.

Author

Scappaticcio L, Trimboli P, Iorio S, Maiorino MI, Longo M, Croce L, Pignatelli MF, Ferrandes S, Cozzolino I, Montella M, Ronchi A, Franco R, Rotondi M, Docimo G, Esposito K, and Bellastella G

Subjects
Adult, Biopsy, Fine-Needle methods, Humans, Middle Aged, Observer Variation, Retrospective Studies, Thyroid Nodule pathology
Abstract

Our institution (University Hospital "L. Vanvitelli" - Naples, Italy) is a high-volume (HV) center in Naples metropolitan area and many patients are referred there to repeat thyroid fine-needle aspiration cytology (FNAC) after initial FNAC performed in low-volume institutions (LV). The aims of the study were to 1) examine the inter-observer agreement between HV and LV institutions according to the Italian thyroid cytology system, and 2) explore how the discordant FNAC reports were distributed in the European Thyroid Imaging and Reporting Data System (EU-TIRADS) categories. All consecutive cases of repeat FNAC performed at University Hospital "L. Vanvitelli" from January 2016 to December 2021 were retrospectively reviewed. Fleiss' kappa (κ) was used to assess the inter-observer agreement, and categorical variables were compared by chi-square testing. P < 0.05 was considered statistically significant. A total of 124 nodules from 124 adults (mean age 49 years; mean maximum diameter 19 mm) were evaluated. Initial FNAC reports at LV were: 4 (3.2%) TIR1c, 64 (51.6%) TIR2, 48 (38.7%) TIR3A, 8 (6.5%) TIR3B, 0 TIR4, 0 TIR5. The overall FNAC reports were significantly different between the LV and HV institutions. At repeated FNAC, cytological diagnosis was unchanged in 64 (51.6%) cases including TIR2 and TIR3A results. A downgraded FNAC diagnosis (i.e., TIR2 vs TIR3A, TIR2 vs TIR3B) was observed in 36 (29%) nodules. An upgraded FNAC diagnosis (i.e., TIR3B vs TIR2, TIR3B vs TIR3A, TIR4 vs TIR3A, TIR5 vs TIR2, TIR5 vs TIR3B) was recorded in 24 (19.4%) nodules. The weighted inter-observer agreement between LV and HV institutions was poor (κ=0.133). Changed FNAC results were significantly (p=0.0023) more frequent in nodules at intermediate/high-risk (i.e., EU-TIRADS 4/5) than in those at no/low risk (EU-TIRADS 2/3) [i.e., 32/48 (66.7%) and 28/76 (36.8%), respectively]. Downgraded FNAC results were significantly more frequent in EU-TIRADS 2/3 (p=0.001) while upgraded FNAC were present only in EU-TIRADS 4/5 (24/24, 100.0%). The inter-observer agreement among LV and HV thyroid services was poor. The EU-TIRADS 4 and 5 categories included all the malignant nodules with FNAC results reclassified as higher risk (i.e., TIR3B-TIR4-TIR5) by the high-volume cytology service., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Scappaticcio, Trimboli, Iorio, Maiorino, Longo, Croce, Pignatelli, Ferrandes, Cozzolino, Montella, Ronchi, Franco, Rotondi, Docimo, Esposito and Bellastella.)

Published
2022
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48. Soft Skills Are Hard Skills-A Historical Perspective.

Author

Iorio S, Cilione M, Martini M, Tofani M, and Gazzaniga V

Subjects
Humans, Hippocratic Oath, Physicians
Abstract

The increasingly swift changes in the field of medicine require a reassessment of the skills necessary for the training of technically qualified doctors. Today's physicians also need to be capable of managing the complex issue of personal relationships with patients. Recent pedagogical debates have focused on so-called "soft skills", whose acquisition is presented in literature as a quite recent addition to medical studies. Moreover, the historical investigation of deontological texts dating from the mid-nineteenth century back to the Hippocratic Oath shows that medicine has always discussed the need to integrate technical expertise in medicine with specific personal and relationship-based skills. Debates have often circled around whether these "soft skills" could actually be taught or how they could be successfully transmitted to training physicians. The belief that defining medicine is more complex than defining other similar sciences and that the instruments to be used in the relationship with patients cannot be limited to those provided by technical aspects shows a new awareness. Today, this view is often stated as an innovative realization on the part of doctors with regard to the complexity of training and action in a delicate area in which they are entrusted with the management of the balance of the system that is the human body.

Published
2022
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49. Exploring global needs of migrants with disability within a community-based inclusive development perspective.

Author

Tofani M, Berardi A, Iorio S, Galeoto G, and Marceca M

Subjects
Educational Status, Health Services Accessibility, Humans, World Health Organization, Persons with Disabilities, Refugees, Transients and Migrants
Abstract

Introduction: Limited evidence exists on migrants with disability. A comprehensive assessment is mandatory required to organize specific services within the community and reception centers. The present study explores needs of refugees and asylum seeker within a community-based inclusive development framework., Methods: To interview migrants, in this study we used the Community-Based Rehabilitation Indicators (CBR-Is) developed by the World Health Organization., Results: The sample consisted of 41 people with disability and 59 without disability. Sample was homogeneous for gender and age. Our findings reveal how migrants with disability experienced poor outcomes in each domain of CBR-Is, namely health, education, livelihood, social end empowerment., Conclusion: Differences between migrants with and without disabilities have some distinctive features. However, both groups are influenced by the social determinants of health: in addition to health issues, challenges in social life, livelihood and empowerment also clearly emerge. Different stakeholders are invited to promote inclusive communities, facilitating access to social and health services.

Published
2022
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50. Community-Based Rehabilitation Indicators: Validation and Preliminary Evidence for Disability in Italy.

Author

Tofani M, Esposito G, Berardi A, Galeoto G, Iorio S, and Marceca M

Subjects
Humans, Italy, Reproducibility of Results, Surveys and Questionnaires, World Health Organization, Community Health Services, Persons with Disabilities
Abstract

Community-based rehabilitation (CBR) is a multi-sectorial community strategy for guaranteeing that people with disabilities enjoy the same rights and opportunities as all other community members. CBR is organized in a five-component matrix-namely, health, education, social, livelihood, and empowerment. To measure the effectiveness of CBR, the World Health Organization (WHO) has developed standardized indicators. The objective of the present study is to translate and validate the CBR indicators (CBR-Is), providing preliminary evidence of their use for disability in Italy. After obtaining permission from the WHO, the CBR-Is followed a process of translation and cross-cultural adaptation according to international guidelines. An examination of internal consistency and reliability was than performed. The intra-rater reliability was estimated using the Intraclass Correlation Coefficient with a 95% confidence interval. In order to measures the differences between people with and without disabilities, an independent sample t -test was used for quantitative indicators. The Italian version of the CBR-Is (IT-CBR-Is) was administered to 234 people. The internal consistency showed a good value, with a Cronbach's alpha coefficient of 0.862, and the intra-rater reliability analysis showed solid values for each domain (range: 0.723-0.882). Statistically significant differences between people with and without disabilities were found for each domain of the CBR matrix-namely, health, social, education, livelihood, and empowerment. The IT-CBR-Is are consistent and reliable measures when used to investigate disability in a community-based inclusive development perspective. National stakeholders can now have specific indicators to implement services and actions for people with disabilities.

Published
2021
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